Basic Information
| Provider Information | |||||||||
| NPI: | 1275528374 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | WINDSOR NURSING HOME ASSOCIATES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | WINDSOR ESTATES | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 623 S 3RD ST | ||||||||
| Address2: | |||||||||
| City: | SALINA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 674014104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858256757 | ||||||||
| FaxNumber: | 7858258019 | ||||||||
| Practice Location | |||||||||
| Address1: | 623 S 3RD ST | ||||||||
| Address2: | |||||||||
| City: | SALINA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 674014104 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858256757 | ||||||||
| FaxNumber: | 7858258019 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/14/2005 | ||||||||
| LastUpdateDate: | 07/10/2012 | ||||||||
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| AuthorizedOfficialLastName: | MCCALL | ||||||||
| AuthorizedOfficialFirstName: | DORIS | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR OF OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 7858256757 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | N085004 | KS | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 100107970A | 05 | KS | MEDICAID | 392 | 01 | KS | KS BCBS PROVIDER # | OTHER | 100308010A | 05 | KS | MEDICAID |