Organization
PETERSON HEALTH CARE, INC.
Active
Parent organization
CRYSTAL CARE CENTERS, INC
Other names
Peterson Nursing Home
Organization subpart
Yes
Provider details
NPI number
Legal business name
CRYSTAL CARE CENTERS, INC
Authorized official
MS. CRYSTAL W PETERSON (ADMINISTRATOR)
(785) 528-4420
Entity
Organization
Contact information
Practice address
630 HOLLIDAY ST, OSAGE CITY, KS 66523-1138
(785) 528-4420
(785) 528-3501
Mailing address
630 HOLLIDAY ST, OSAGE CITY, KS 66523-1138
(785) 528-4420
(785) 528-3501
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
N070004
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100109480A
—
KS
01
—
1175
BLUE CROSS BLUE SHIELD
KS
Enumeration date
08/25/2006
Last updated
01/27/2012
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