PRISCILLA C NELSON
Adult Care Home
Wichita, Kansas
Provider NPI: 1497979959
Organization Information:Organization Name: PRISCILLA C NELSON
Practice Location:
1316 N CHARLOTTE WICHITA, KS 67208 US
Tel: 316-440-4406 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Other Provider Identifiers:
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin
Practice Location:
1316 N CHARLOTTE WICHITA, KS 67208 US
Tel: 316-440-4406 Fax: --
Business Mailing Address:
,
Tel: -- Fax: --
Taxonomy:
Primary | Code | Category/Description | State | License Number |
---|---|---|---|---|
Y | 311ZA0620X | Nursing & Custodial Care Facilities Custodial Care Facility Adult Care Home | KS | B087145 |
Other Provider Identifiers:
Issuer | Number | State | Type |
---|---|---|---|
200400780A | KS | 05 | |
200543750A | KS | 05 |
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin