Provider Demographics
NPI:1528061124
Name:VIA CHRISTI VILLAGE MANHATTAN, INC.
Entity type:Organization
Organization Name:VIA CHRISTI VILLAGE MANHATTAN, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KELLIE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:GRONEFELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-729-3500
Mailing Address - Street 1:2800 WILLOW GROVE RD
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66502-2105
Mailing Address - Country:US
Mailing Address - Phone:785-539-7671
Mailing Address - Fax:785-539-9125
Practice Address - Street 1:2800 WILLOW GROVE RD
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2105
Practice Address - Country:US
Practice Address - Phone:785-539-7671
Practice Address - Fax:785-539-9125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-27
Last Update Date:2024-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN081001310400000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100107790BOtherHCBS
KS100107790CMedicaid
KS100107790BOtherHCBS