Provider Demographics
NPI:1104543339
Name:PLATINUM CARE HOMES LLC
Entity type:Organization
Organization Name:PLATINUM CARE HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:MACK
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:316-807-6761
Mailing Address - Street 1:5701 E 17TH ST N
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-1703
Mailing Address - Country:US
Mailing Address - Phone:316-807-6761
Mailing Address - Fax:316-239-7821
Practice Address - Street 1:5701 E 17TH ST N
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-1703
Practice Address - Country:US
Practice Address - Phone:316-807-6761
Practice Address - Fax:316-239-7821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-27
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home