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General NPI Number Information
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NPI Number | 1538123484
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Entity Type | Organization
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Legal Business Name | MANASSEH HEALTH LLC
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Dates
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Enumeration Date | 04/15/2006
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Last Update Date | 03/19/2010
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Provider Practice Location Address
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Address Line | 808 N 8TH ST
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City | SENECA
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State | KS
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Zip | 66538-1419
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Country | US
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Telephone | 785-336-2156
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Fax | 785-336-3881
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Provider Business Mailing Address
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Address Line | 808 N 8TH ST
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City | SENECA
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State | KS
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Zip | 66538-1419
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Country | US
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Telephone | 785-336-2156
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Fax | 785-336-3881
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Authorized Official
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Title or Position | MGR OF LLC
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Name | MR. SCOTT EDWARD GULLEDGE
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Credential |
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Telephone | 913-485-5164
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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 | N066-003
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License Number State | KS
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