1497894463 NPI number — SA-ENC TONGANOXIE, LLC

Table of content: (NPI 1497894463)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497894463 NPI number — SA-ENC TONGANOXIE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SA-ENC TONGANOXIE, LLC
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:
TONGANOXIE NURSING CENTER
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:
1497894463
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
44 S BROADWAY
Provider Second Line Business Mailing Address:
SUITE 614
Provider Business Mailing Address City Name:
WHITE PLAINS
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10601-4425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
914-390-4366
Provider Business Mailing Address Fax Number:
866-280-2653

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1010 EAST ST # 940
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TONGANOXIE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66086-9557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-369-8705
Provider Business Practice Location Address Fax Number:
913-369-2787
Provider Enumeration Date:
02/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MARKENSON
Authorized Official First Name:
ARI
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSOCIATE GENERAL COUNSEL
Authorized Official Telephone Number:
914-390-4366

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  N052005 , 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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