Provider Demographics
NPI:1346576311
Name:SOUTHERN HOSPITALITY HOME
Entity type:Organization
Organization Name:SOUTHERN HOSPITALITY HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:D
Authorized Official - Last Name:MURRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-839-2827
Mailing Address - Street 1:20687 W 125TH CT
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7822
Mailing Address - Country:US
Mailing Address - Phone:913-839-2827
Mailing Address - Fax:913-839-2827
Practice Address - Street 1:20687 W 125TH CT
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7822
Practice Address - Country:US
Practice Address - Phone:913-839-2827
Practice Address - Fax:913-839-2827
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSB046041311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home