Basic Information
| Provider Information | |||||||||
| NPI: | 1770253114 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AP HOMES OPERATIONS HIAWATHA KS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 302 E IOWA ST | ||||||||
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| City: | HIAWATHA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 664349826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7857427465 | ||||||||
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| Address1: | 302 E IOWA ST | ||||||||
| Address2: | |||||||||
| City: | HIAWATHA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 664349826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7857427465 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2021 | ||||||||
| LastUpdateDate: | 09/16/2021 | ||||||||
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| AuthorizedOfficialLastName: | SHIELDS | ||||||||
| AuthorizedOfficialFirstName: | STEVE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7853134059 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 09/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | Y | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility |
ID Information
| ID | Type | State | Issuer | Description | 201327150B | 05 | KS | MEDICAID |