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General NPI Number Information
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NPI Number | 1639624364
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Entity Type | Organization
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Legal Business Name | PRIME HEALTHCARE SERVICES-PROVIDENCE, LLC
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Dates
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Enumeration Date | 08/23/2016
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Last Update Date | 08/23/2016
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Provider Practice Location Address
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Address Line | 8929 PARALLEL PKWY
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City | KANSAS CITY
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State | KS
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Zip | 66112-1689
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Country | US
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Telephone | 913-596-3229
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Fax |
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Provider Business Mailing Address
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Address Line | 8929 PARALLEL PKWY
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City | KANSAS CITY
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State | KS
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Zip | 66112-1689
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Country | US
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Telephone | 913-596-3229
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Fax |
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Authorized Official
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Title or Position | CHIEF COMPLIANCE COUNSEL
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Name | CHRISTOPHER DOAN
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Credential |
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Telephone | 909-235-4307
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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 | N105013
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License Number State | KS
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