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General NPI Number Information
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NPI Number | 1851569818
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Entity Type | Organization
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Legal Business Name | MYSTERE LIVING & HEALTHCARE, INC.
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Dates
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Enumeration Date | 02/13/2008
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Last Update Date | 10/26/2022
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Provider Practice Location Address
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Address Line | 304 W 7TH ST
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City | WELLSVILLE
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State | KS
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Zip | 66092-7800
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Country | US
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Telephone | 785-883-4101
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Fax |
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Provider Business Mailing Address
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Address Line | 304 W 7TH ST
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City | WELLSVILLE
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State | KS
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Zip | 66092-7800
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Country | US
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Telephone | 785-883-4101
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SCOTT G AVERILL
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Credential |
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Telephone | 785-883-4101
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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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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | N030004
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License Number State | KS
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