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General NPI Number Information
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NPI Number | 1720561541
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Entity Type | Organization
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Legal Business Name | MEDICALODGES, INC.
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Dates
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Enumeration Date | 09/07/2018
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Last Update Date | 09/07/2018
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Provider Practice Location Address
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Address Line | 1401 CHERRY LN
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City | GREAT BEND
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State | KS
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Zip | 67530-3152
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Country | US
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Telephone | 620-792-2165
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Fax | 620-793-6341
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Provider Business Mailing Address
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Address Line | 1401 CHERRY LN
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City | GREAT BEND
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State | KS
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Zip | 67530-3152
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Country | US
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Telephone | 620-792-2165
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Fax | 620-793-6341
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Authorized Official
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Title or Position | CFO
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Name | SCOTT HINES
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Credential |
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Telephone | 620-709-0305
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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