Basic Information
| Provider Information | |||||||||
| NPI: | 1861167256 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CLAY CENTER LIVING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2310 ANDERSON AVE | ||||||||
| Address2: | |||||||||
| City: | MANHATTAN | ||||||||
| State: | KS | ||||||||
| PostalCode: | 665022967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7857894750 | ||||||||
| FaxNumber: | 7857894756 | ||||||||
| Practice Location | |||||||||
| Address1: | 715 LIBERTY ST | ||||||||
| Address2: | |||||||||
| City: | CLAY CENTER | ||||||||
| State: | KS | ||||||||
| PostalCode: | 674321528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7856325696 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/09/2021 | ||||||||
| LastUpdateDate: | 08/09/2021 | ||||||||
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| AuthorizedOfficialLastName: | NOVOTNY | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7853130946 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| NPICertificationDate: | 08/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251J00000X | Y | Agencies | Nursing Care |
No ID Information.