Organization
COUNTRY ANGELS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY O CASE (OWNER)
(620) 856-5418
Entity
Organization
Contact information
Practice address
2067 E 12TH ST, BAXTER SPRINGS, KS 66713-2657
(620) 856-5418
(620) 856-1932
Mailing address
2067 E 12TH ST, BAXTER SPRINGS, KS 66713-2657
(620) 856-5418
(620) 856-1932
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
B011001
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200637940A
—
KS
Enumeration date
05/10/2012
Last updated
05/10/2012
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