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Organization
PROVIDENCE PLACE, INC.
Active
Organization
PROVIDENCE PLACE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MIKE WARREN (ADMINISTRATOR)
(913) 596-4200
Entity
Organization
Contact information
Practice address
8909 PARALLEL PKWY, KANSAS CITY, KS 66112-1689
(913) 596-4200
(913) 596-4904
Mailing address
8909 PARALLEL PKWY, KANSAS CITY, KS 66112-1689
(913) 596-4200
(913) 596-4904
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
N105013
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200972460A
—
KS
Enumeration date
06/10/2005
Last updated
04/26/2013
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