Organization
MEDICALODGES, INC.
Active
Other names
Gran Villas Pittsburg
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SCOTT L HINES (CHIEF FINANCIAL OFFICER)
(620) 709-0305
Entity
Organization
Contact information
Practice address
1004 E CENTENNIAL DR, PITTSBURG, KS 66762-6565
(620) 231-4554
(620) 231-1156
Mailing address
1004 E CENTENNIAL DR, PITTSBURG, KS 66762-6565
(620) 231-4554
(620) 231-1156
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
N019009
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
N019009
STATE LICENSE NUMBER
KS
Enumeration date
06/05/2012
Last updated
07/30/2012
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