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General NPI Number Information
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NPI Number | 1598863763
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Entity Type | Organization
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Legal Business Name | MT JOSEPH SENIOR VILLAGE LLC
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 06/25/2008
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Provider Practice Location Address
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Address Line | 1110 W 11TH ST
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City | CONCORDIA
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State | KS
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Zip | 66901-3902
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Country | US
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Telephone | 785-243-1347
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Fax | 785-243-1907
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Provider Business Mailing Address
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Address Line | 1110 W 11TH ST
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City | CONCORDIA
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State | KS
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Zip | 66901-3902
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Country | US
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Telephone | 785-243-1347
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Fax | 785-243-1907
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | JANET G. CHAPMAN
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Credential |
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Telephone | 785-243-1347
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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 | N015003
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License Number State | KS
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