# PROVIDENCE PLACE, INC.

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

## Provider details

- **NPI number:** 1750385217
- **Authorized official:** MIKE WARREN (ADMINISTRATOR)
- **Authorized official phone:** (913) 596-4200

## Contact information

- **Practice address:** 8909 PARALLEL PKWY, KANSAS CITY, KS 66112-1689
- **Practice address phone:** (913) 596-4200
- **Practice address fax:** (913) 596-4904
- **Mailing address:** 8909 PARALLEL PKWY, KANSAS CITY, KS 66112-1689
- **Mailing address phone:** (913) 596-4200
- **Mailing address fax:** (913) 596-4904

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | N105013 | KS | Yes |

## Other

- **Enumeration date:** 06/10/2005
- **Last updated:** 04/26/2013

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 200972460A | — | KS |