MEDICARE: AHG BLACKHAWK, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	N046066	KS

General Provider Information

NPI Number	:	1184876427
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AHG BLACKHAWK, LLC

Provider Business Mailing Address
First Line	:	22550 S FRANKLIN ST
Second Line	:
City	:	SPRING HILL
State	:	KS
Zip	:	66083-8763
Country	:	US
Telephone Number	:	913-592-5101
Fax Number	:	913-307-0196

Provider Business Practice Location Address
First Line	:	22550 S FRANKLIN ST
Second Line	:
City	:	SPRING HILL
State	:	KS
Zip	:	66083-8763
Country	:	US
Telephone Number	:	913-592-5101
Fax Number	:	913-307-0196

Authorized Official
Title or Position	:	SECRETARY
Name	:	MR. NORMAN GUY WILCOX
Credential	:
Telephone Number	:	913-592-5101

Provider Enumeration Date	:	10/17/2008
Last Update Date	:	10/17/2008

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Directions to “AHG BLACKHAWK, LLC ” Practice Location

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