MEDICARE: WELLSPRINGS OF GARDEN PLAIN

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	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1912326463
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WELLSPRINGS OF GARDEN PLAIN

Provider Business Mailing Address
First Line	:	6311 MARJORIE ST
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67208-3629
Country	:	US
Telephone Number	:	316-390-3816
Fax Number	:

Provider Business Practice Location Address
First Line	:	101 W AVENUE C
Second Line	:
City	:	GARDEN PLAIN
State	:	KS
Zip	:	67050-9574
Country	:	US
Telephone Number	:	316-390-3816
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR/OWNER
Name	:	JENNIFER SCHECK
Credential	:
Telephone Number	:	316-390-3816

Provider Enumeration Date	:	04/14/2014
Last Update Date	:	04/14/2014

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