MEDICARE: KIDRON BETHEL RETIREMENT SERVICES, INC.

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
2	314000000X	Skilled Nursing Facility	N040-001	KS
3	314000000X	Skilled Nursing Facility	N-040-001	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	100107280B	OTHER	KS	HCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	10010728B	OTHER	KS	HCBS-KS

General Provider Information

NPI Number	:	1629068838
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIDRON BETHEL RETIREMENT SERVICES, INC.

Provider Business Mailing Address
First Line	:	3001 IVY DRIVE
Second Line	:
City	:	NORTH NEWTON
State	:	KS
Zip	:	67117-8002
Country	:	US
Telephone Number	:	316-284-2900
Fax Number	:	316-284-0173

Provider Business Practice Location Address
First Line	:	3001 IVY DRIVE
Second Line	:
City	:	NORTH NEWTON
State	:	KS
Zip	:	67117-8002
Country	:	US
Telephone Number	:	316-284-2900
Fax Number	:	316-284-0173

Authorized Official
Title or Position	:	CEO
Name	:	JAMES KREHBIEL
Credential	:
Telephone Number	:	316-284-2900

Provider Enumeration Date	:	10/27/2005
Last Update Date	:	10/20/2022

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