# MEDICALODGES, INC.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Gran Villas Pittsburg
- **Organization subpart:** No

## Provider details

- **NPI number:** 1437410651
- **Authorized official:** MR. SCOTT L HINES (CHIEF FINANCIAL OFFICER)
- **Authorized official phone:** (620) 709-0305

## Contact information

- **Practice address:** 1004 E CENTENNIAL DR, PITTSBURG, KS 66762-6565
- **Practice address phone:** (620) 231-4554
- **Practice address fax:** (620) 231-1156
- **Mailing address:** 1004 E CENTENNIAL DR, PITTSBURG, KS 66762-6565
- **Mailing address phone:** (620) 231-4554
- **Mailing address fax:** (620) 231-1156

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | N019009 | KS | Yes |

## Other

- **Enumeration date:** 06/05/2012
- **Last updated:** 07/30/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | N019009 | STATE LICENSE NUMBER | KS |