# KANSAS MASONIC HOME

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kansas Masonic Home
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437244654
- **Authorized official:** MR. MATTHEW BOGNER (C.E.O.)
- **Authorized official phone:** (316) 269-7650

## Contact information

- **Practice address:** 401 S SENECA ST, WICHITA, KS 67213-5541
- **Practice address phone:** (316) 269-7652
- **Practice address fax:** (316) 269-7643
- **Mailing address:** 401 S SENECA ST, WICHITA, KS 67213-5541
- **Mailing address phone:** (316) 269-7652
- **Mailing address fax:** (316) 269-7643

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | N087008 | KS | Yes |

## Other

- **Enumeration date:** 10/04/2006
- **Last updated:** 07/10/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 0578 | BCBS | — |
| 05 | — | 100107460A | — | KS |