# WHEAT HAVEN HOME LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396438958
- **Authorized official:** BRADLEY PORUBSKY (MEMBER)
- **Authorized official phone:** (785) 230-0244

## Contact information

- **Practice address:** 304 MARION ST, MCDONALD, KS 67745
- **Practice address phone:** (785) 230-0244
- **Mailing address:** PO BOX 87, MC DONALD, KS 67745-0087
- **Mailing address phone:** (785) 899-9009
- **Mailing address fax:** (785) 414-5055

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 311ZA0620X | Adult Care Home Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 05/31/2023
- **Last updated:** 05/31/2023