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NPI Code Detail

MEDICARE: PROVIDENCE PLACE, INC.

MEDICARE: PROVIDENCE PLACE, 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
1314000000XSkilled Nursing FacilityN105013KS

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 : 1750385217
Entity Type Code : Organization
Provider Name (Legal Business Name) : PROVIDENCE PLACE, INC.
Provider Business Mailing Address
First Line : 8909 PARALLEL PKWY
Second Line :
City : KANSAS CITY
State : KS
Zip : 66112-1689
Country : US
Telephone Number : 913-596-4200
Fax Number : 913-596-4904
Provider Business Practice Location Address
First Line : 8909 PARALLEL PKWY
Second Line :
City : KANSAS CITY
State : KS
Zip : 66112-1689
Country : US
Telephone Number : 913-596-4200
Fax Number : 913-596-4904
Authorized Official
Title or Position : ADMINISTRATOR
Name : MIKE WARREN
Credential :
Telephone Number : 913-596-4200
Provider Enumeration Date : 06/10/2005
Last Update Date : 04/26/2013

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Directions to “PROVIDENCE PLACE, INC. ” Practice Location

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