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General NPI Number Information
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NPI Number | 1801322714
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Entity Type | Organization
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Legal Business Name | ULTRA CARE HOME PLUS LLC
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 11537 E HARRY ST
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City | WICHITA
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State | KS
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Zip | 67207-6225
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Country | US
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Telephone | 316-990-5476
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Fax |
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Provider Business Mailing Address
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Address Line | 11537 E HARRY ST
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City | WICHITA
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State | KS
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Zip | 67207-6225
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPERATOR
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Name | TOLULOPE KADIRI
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Credential |
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Telephone | 316-990-5476
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311ZA0620X
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Taxonomy Name | Adult Care Home Facility
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License Number | B087220
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License Number State | KS
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