Provider Demographics
NPI:1225036247
Name:ELK MANOR NURSING, LLC
Entity type:Organization
Organization Name:ELK MANOR NURSING, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:REIKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-471-1113
Mailing Address - Street 1:304 WALNUT
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:KS
Mailing Address - Zip Code:67353-9021
Mailing Address - Country:US
Mailing Address - Phone:620-647-3235
Mailing Address - Fax:620-647-3452
Practice Address - Street 1:304 WALNUT
Practice Address - Street 2:
Practice Address - City:MOLINE
Practice Address - State:KS
Practice Address - Zip Code:67353-9021
Practice Address - Country:US
Practice Address - Phone:620-647-3235
Practice Address - Fax:620-647-3452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN025001314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1042547401Medicaid