1821478140 NPI number — SENIOR CARE SERVICES INC

Table of content: (NPI 1659049989)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821478140 NPI number — SENIOR CARE SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SENIOR CARE SERVICES 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:
SCP- PRAIRIE STAR PHARMACY
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:
1821478140
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1402 S RIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67209-2908
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-945-7455
Provider Business Mailing Address Fax Number:
316-945-7457

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 E 30TH AVE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HUTCHINSON
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67502-1242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-802-0666
Provider Business Practice Location Address Fax Number:
620-663-8890
Provider Enumeration Date:
06/02/2015

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
FRANKLIN
Authorized Official Middle Name:
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
316-945-7455

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , with the licence number: 2-13175 , 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)

  • Identifier: 2152258 . This is a "PK" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100459190C , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".




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