Organization
SHANK HOME LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JULIA A TUBBS (OWNER/OPERATOR)
(620) 353-5351
Entity
Organization
Contact information
Practice address
111 W RAILROAD AVE, PO BOX A, LAKIN, KS 67860-6040
(620) 355-6803
(620) 355-6215
Mailing address
111 W RAILROAD AVE, PO BOX A, LAKIN, KS 67860-6040
(620) 355-6803
(620) 355-6215
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
B047001
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200677620A
—
KS
Enumeration date
01/30/2013
Last updated
01/30/2013
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