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NPI Code Detail

MEDICARE: SENIOR HEALTHCARE, LLC

MEDICARE: SENIOR HEALTHCARE, 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
1364SG0600XGerontology Clinical Nurse Specialist74308KS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639454044
Entity Type Code : Organization
Provider Name (Legal Business Name) : SENIOR HEALTHCARE, LLC
Provider Business Mailing Address
First Line : 302 SOUTHERN HILLS DR
Second Line :
City : COFFEYVILLE
State : KS
Zip : 67337-9623
Country : US
Telephone Number : 316-992-1591
Fax Number :
Provider Business Practice Location Address
First Line : 2921 W 1ST ST
Second Line :
City : COFFEYVILLE
State : KS
Zip : 67337-2441
Country : US
Telephone Number : 620-251-5190
Fax Number :
Authorized Official
Title or Position : ARNP
Name : DANA E MORTON
Credential :
Telephone Number : 316-992-1591
Provider Enumeration Date : 10/17/2011
Last Update Date : 10/17/2011

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Directions to “SENIOR HEALTHCARE, LLC ” Practice Location

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