# MOUNDRIDGE MANOR INC.

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

## Provider details

- **NPI number:** 1972578037
- **Authorized official:** MR. KEVIN W UNRUH (ADMINISTRATOR)
- **Authorized official phone:** (620) 345-6364

## Contact information

- **Practice address:** 710 NORTH CHRISTIAN AVENUE, MOUNDRIDGE, KS 67107
- **Practice address phone:** (620) 345-6364
- **Practice address fax:** (620) 345-6376
- **Mailing address:** P.O. BOX 800, MOUNDRIDGE, KS 67107
- **Mailing address phone:** (620) 345-6364
- **Mailing address fax:** (620) 345-6376

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 313M00000X | Nursing Facility/Intermediate Care Facility | N059003 | KS | Yes |

## Other

- **Enumeration date:** 02/22/2006
- **Last updated:** 06/16/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100109430A | — | KS |