MEDICARE: THE W PLACE, 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

General Provider Information

NPI Number	:	1194408484
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE W PLACE, LLC

Provider Business Mailing Address
First Line	:	510 ALLISON DR
Second Line	:
City	:	CHENEY
State	:	KS
Zip	:	67025-9056
Country	:	US
Telephone Number	:	620-243-2674
Fax Number	:

Provider Business Practice Location Address
First Line	:	1211 W KELLY AVE
Second Line	:
City	:	KINGMAN
State	:	KS
Zip	:	67068-8168
Country	:	US
Telephone Number	:	620-243-2674
Fax Number	:

Authorized Official
Title or Position	:	OPERATOR
Name	:	MRS. JENNILEE ROSE LOEHR
Credential	:	RN
Telephone Number	:	620-243-2674

Provider Enumeration Date	:	08/11/2023
Last Update Date	:	08/11/2023

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Directions to “THE W PLACE, LLC ” Practice Location

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