Basic Information
| Provider Information | |||||||||
| NPI: | 1417139585 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | DESERET NURSING AND REHABILITATION AT WICHITA, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 S WOODLAWN BLVD | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672184728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166919999 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1600 S WOODLAWN BLVD | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672184728 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166919999 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2007 | ||||||||
| LastUpdateDate: | 11/30/2007 | ||||||||
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| AuthorizedOfficialLastName: | ROBERTSON | ||||||||
| AuthorizedOfficialFirstName: | JON | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8012965105 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.