Basic Information
| Provider Information | |||||||||
| NPI: | 1710971858 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OTTAWA RETIREMENT PLAZA, INC. | ||||||||
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| OtherOrganizationName: | OTTAWA PLAZA | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 330 STRAIGHT ST | ||||||||
| Address2: | SUITE 330 | ||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452191064 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5134873600 | ||||||||
| FaxNumber: | 5134873612 | ||||||||
| Practice Location | |||||||||
| Address1: | 1042 W 15TH ST | ||||||||
| Address2: | |||||||||
| City: | OTTAWA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660673951 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852421127 | ||||||||
| FaxNumber: | 7852421536 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2005 | ||||||||
| LastUpdateDate: | 04/19/2012 | ||||||||
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| AuthorizedOfficialLastName: | RAUPACH | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | COO | ||||||||
| AuthorizedOfficialTelephone: | 5134873600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3747P1801X | NO3006 | KS | N | 193400000X SINGLE SPECIALTY GROUP | Nursing Service Related Providers | Technician | Personal Care Attendant | 261QA0600X | NO3006 | KS | N | Ambulatory Health Care Facilities | Clinic/Center | Adult Day Care | 251E00000X | NO3006 | KS | N | Agencies | Home Health | 332B00000X | NO3006 | KS | N | Suppliers | Durable Medical Equipment & Medical Supplies | 310400000X | NO3006 | KS | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
ID Information
| ID | Type | State | Issuer | Description | 100019200A | 05 | KS | MEDICAID | NO3006 | 01 | KS | ADULT CARE HOME LICENSE | OTHER |