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General NPI Number Information
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NPI Number | 1427396118
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Entity Type | Organization
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Legal Business Name | SHANK HOME LLC
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Dates
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Enumeration Date | 01/30/2013
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Last Update Date | 01/30/2013
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Provider Practice Location Address
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Address Line | 111 W RAILROAD AVE PO BOX A
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City | LAKIN
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State | KS
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Zip | 67860-6040
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Country | US
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Telephone | 620-355-6803
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Fax | 620-355-6215
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Provider Business Mailing Address
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Address Line | 111 W RAILROAD AVE PO BOX A
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City | LAKIN
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State | KS
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Zip | 67860-6040
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Country | US
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Telephone | 620-355-6803
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Fax | 620-355-6215
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Authorized Official
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Title or Position | OWNER/OPERATOR
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Name | JULIA A TUBBS
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Credential |
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Telephone | 620-353-5351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | B047001
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License Number State | KS
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