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General NPI Number Information
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NPI Number | 1831145986
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Entity Type | Organization
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Legal Business Name | GREAT BEND HOMESTEAD ASSISTED LIVING, LLC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3820 BROADWAY AVE
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City | GREAT BEND
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State | KS
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Zip | 67530-3645
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Country | US
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Telephone | 620-792-7017
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Fax |
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Provider Business Mailing Address
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Address Line | 3820 BROADWAY AVE
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City | GREAT BEND
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State | KS
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Zip | 67530-3645
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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 | TREASURER
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Name | JAMES REIKER
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Credential |
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Telephone | 573-471-1113
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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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