MEDICARE: GARDEN CITY SR OPERATONS 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	311ZA0620X	Adult Care Home Facility

General Provider Information

NPI Number	:	1982145595
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARDEN CITY SR OPERATONS LLC

Provider Business Mailing Address
First Line	:	7200 W 13TH ST N
Second Line	:	STE 5
City	:	WICHITA
State	:	KS
Zip	:	67212-2970
Country	:	US
Telephone Number	:	316-448-0850
Fax Number	:	316-448-0855

Provider Business Practice Location Address
First Line	:	2002 LABRADOR BOULEVARD
Second Line	:
City	:	GARDEN CITY
State	:	KS
Zip	:	67846
Country	:	US
Telephone Number	:	316-448-0850
Fax Number	:	316-448-0855

Authorized Official
Title or Position	:	ACCOUNTING SPECIALIST
Name	:	SANDY HINKLE
Credential	:
Telephone Number	:	316-448-0850

Provider Enumeration Date	:	03/15/2017
Last Update Date	:	03/15/2017

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