# MEMORIAL HOME, INC.

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

## Provider details

- **NPI number:** 1801896782
- **Authorized official:** MR. JASON T STUCKY (CEO)
- **Authorized official phone:** (620) 345-2901

## Contact information

- **Practice address:** 86 22ND AVE, MOUNDRIDGE, KS 67107-7003
- **Practice address phone:** (620) 345-2901
- **Practice address fax:** (620) 345-2937
- **Mailing address:** 86 22ND AVE, MOUNDRIDGE, KS 67107-7003
- **Mailing address phone:** (620) 345-2901
- **Mailing address fax:** (620) 345-2937

## Taxonomy

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

## Other

- **Enumeration date:** 07/21/2005
- **Last updated:** 07/17/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100108790 | — | KS |