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General NPI Number Information
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NPI Number | 1659490126
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Entity Type | Organization
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Legal Business Name | NATIONWIDE HEALTH SYSTEMS
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Dates
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Enumeration Date | 03/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 6538 HALLET ST
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City | SHAWNEE
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State | KS
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Zip | 66216-2209
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Country | US
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Telephone | 913-631-0538
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Fax |
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Provider Business Mailing Address
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Address Line | 11111 W 59TH TER STE 103
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City | SHAWNEE
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State | KS
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Zip | 66203-2713
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Country | US
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Telephone | 913-631-3844
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. TRACY R MATTOX
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Credential | RN
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Telephone | 913-631-3844
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | A046146
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License Number State | KS
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