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General NPI Number Information
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NPI Number | 1952516346
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Entity Type | Organization
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Legal Business Name | KANSAS MASONIC HOME, INC.
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Dates
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Enumeration Date | 05/11/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 401 S SENECA ST
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City | WICHITA
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State | KS
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Zip | 67213-5541
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Country | US
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Telephone | 316-269-7652
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Fax | 316-267-2199
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Provider Business Mailing Address
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Address Line | 401 S SENECA ST
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City | WICHITA
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State | KS
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Zip | 67213-5541
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Country | US
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Telephone | 316-269-7652
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Fax | 316-267-2199
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Authorized Official
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Title or Position | DIRECTOR OF FINANCE
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Name | TIM C NIKKEL
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Credential |
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Telephone | 316-269-7652
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 315D00000X
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Taxonomy Name | Inpatient Hospice
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License Number | Z087011
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License Number State | KS
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