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General NPI Number Information
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NPI Number | 1669782231
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Entity Type | Organization
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Legal Business Name | GRACIOUS SENIOR LIVING, LLC
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Dates
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Enumeration Date | 10/18/2010
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Last Update Date | 10/18/2010
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Provider Practice Location Address
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Address Line | 551 S. HOLLAND
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City | WICHITA
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State | KS
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Zip | 67209
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Country | US
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Telephone | 316-771-7316
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Fax | 316-771-7319
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Provider Business Mailing Address
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Address Line | 3825 E. HARRY
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City | WICHITA
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State | KS
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Zip | 67218-3722
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Country | US
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Telephone | 316-771-7316
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Fax | 316-771-7319
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | CHRISTINE BACCI
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Credential |
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Telephone | 316-771-7316
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | B087171
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License Number State | KS
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