Provider Demographics
NPI:1063989432
Name:RICE COUNTY ASSISTED LIVING LLC
Entity type:Organization
Organization Name:RICE COUNTY ASSISTED LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:THERESA
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:622-285-6900
Mailing Address - Street 1:714 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:LARNED
Mailing Address - State:KS
Mailing Address - Zip Code:67550-2452
Mailing Address - Country:US
Mailing Address - Phone:620-285-6900
Mailing Address - Fax:620-285-6907
Practice Address - Street 1:502 S MILES AVE
Practice Address - Street 2:
Practice Address - City:LYONS
Practice Address - State:KS
Practice Address - Zip Code:67554-3008
Practice Address - Country:US
Practice Address - Phone:620-257-5012
Practice Address - Fax:620-257-5304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSN080004Medicaid