Provider Demographics
NPI:1699244384
Name:ANTHEM WICHITA MANAGEMENT, LLC
Entity type:Organization
Organization Name:ANTHEM WICHITA MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:L
Authorized Official - Last Name:DINSMORE
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:316-558-5775
Mailing Address - Street 1:1859 N WEBB RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3413
Mailing Address - Country:US
Mailing Address - Phone:316-558-5775
Mailing Address - Fax:316-558-5763
Practice Address - Street 1:1859 N WEBB RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3413
Practice Address - Country:US
Practice Address - Phone:316-558-5775
Practice Address - Fax:316-558-5763
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AMC-WICHITA, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-11-25
Last Update Date:2018-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)