# MAIZE CCRC, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** JUPITER TENANT, LLC
- **Other names:** Park West Plaza
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1922446350
- **Legal business name:** JUPITER TENANT, LLC
- **Authorized official:** MR. CHRISTOPHER WETTIG (CFO)
- **Authorized official phone:** (316) 616-6288

## Contact information

- **Practice address:** 505 N MAIZE RD, WICHITA, KS 67212-4689
- **Practice address phone:** (316) 729-4114
- **Mailing address:** 8415 E 21ST ST N STE 100, WICHITA, KS 67206-2959
- **Mailing address phone:** (316) 616-6288
- **Mailing address fax:** (316) 616-6255

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | N087046 | KS | Yes |

## Other

- **Enumeration date:** 06/07/2013
- **Last updated:** 06/07/2013