Provider Demographics
NPI:1316058373
Name:PRESBYTERIAN MANORS, INC.
Entity type:Organization
Organization Name:PRESBYTERIAN MANORS, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOODSMALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-652-6242
Mailing Address - Street 1:PO BOX 20440
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-1440
Mailing Address - Country:US
Mailing Address - Phone:316-685-1100
Mailing Address - Fax:316-685-2900
Practice Address - Street 1:17500 W 119TH ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-9524
Practice Address - Country:US
Practice Address - Phone:913-599-6100
Practice Address - Fax:913-599-3810
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESBYTERIAN MANORS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN/A314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100112090AMedicaid
KS17D0988082OtherCLIA
KS709612OtherBLUE CROSS
KS17D0988082OtherCLIA
KS100112090AMedicaid