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General NPI Number Information
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NPI Number | 1437435286
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Entity Type | Organization
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Legal Business Name | GREAT BEND-LTC, LLC
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Dates
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Enumeration Date | 10/25/2011
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Last Update Date | 11/12/2015
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Provider Practice Location Address
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Address Line | 1560 K 96 HWY
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City | GREAT BEND
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State | KS
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Zip | 67530-3012
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Country | US
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Telephone | 678-522-2436
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Fax | 770-663-4539
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Provider Business Mailing Address
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Address Line | 10945 STATE BRIDGE RD SUITE 401-470
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City | ALPHARETTA
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State | GA
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Zip | 30022-8164
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Country | US
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Telephone | 678-522-2436
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Fax | 770-663-4539
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Authorized Official
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Title or Position | MEMBER CFO
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Name | DAREN G DOUSTON
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Credential |
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Telephone | 678-522-2436
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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