1417946187 NPI number — THE SCOTT COUNTY REST HOME, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417946187 NPI number — THE SCOTT COUNTY REST HOME, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE SCOTT COUNTY REST HOME, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PARK LANE NURSING HOME
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417946187
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
210 E PARK LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTT CITY
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67871-1960
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-872-5871
Provider Business Mailing Address Fax Number:
620-872-2128

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 E PARK LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCOTT CITY
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67871-1960
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-872-5871
Provider Business Practice Location Address Fax Number:
620-872-2128
Provider Enumeration Date:
10/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
TURNER
Authorized Official First Name:
NICOLE
Authorized Official Middle Name:
S
Authorized Official Title or Position:
ADMINISTRATOR/EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
620-872-5871

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  N086001 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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