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General NPI Number Information
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NPI Number | 1942699368
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Entity Type | Organization
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Legal Business Name | WB REAL ESTATE OF IOLA, LLC
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Dates
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Enumeration Date | 01/22/2015
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Last Update Date | 06/12/2015
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Provider Practice Location Address
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Address Line | 2620 N KENTUCKY ST
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City | IOLA
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State | KS
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Zip | 66749-1940
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Country | US
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Telephone | 620-365-6002
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Fax |
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Provider Business Mailing Address
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Address Line | 2620 N KENTUCKY ST
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City | IOLA
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State | KS
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Zip | 66749-1940
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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 | MEMBER
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Name | AMY WILCOX-BURNS
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Credential |
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Telephone | 402-898-1079
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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 |
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License Number State | KS
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