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General NPI Number Information
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NPI Number | 1730489071
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Entity Type | Organization
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Legal Business Name | PEGGY KELLY HOUSE I
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Dates
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Enumeration Date | 11/02/2010
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Last Update Date | 11/02/2010
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Provider Practice Location Address
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Address Line | 2111 SW RANDOLPH AVE
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City | TOPEKA
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State | KS
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Zip | 66611-1547
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Country | US
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Telephone | 785-234-8888
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Fax | 785-234-0885
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Provider Business Mailing Address
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Address Line | 1800 SW FAIRMONT RD
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City | TOPEKA
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State | KS
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Zip | 66604-3699
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Country | US
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Telephone | 785-271-9594
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Fax | 785-271-6638
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Authorized Official
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Title or Position | BUSINESS MANAGER
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Name | MS. SHELLY MARIE LINDENSMITH
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Credential |
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Telephone | 785-271-9594
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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 | N089033
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License Number State | KS
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