Organization
MID-AMERICA AT PEABODY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICTORIA NICHOLS ADMINISTRATOR (ADMINISTRATOR)
(620) 983-2152
Entity
Organization
Contact information
Practice address
407 N LOCUST ST, PEABODY, KS 66866-1117
(620) 983-2152
(620) 983-2281
Mailing address
407 N LOCUST ST, PEABODY, KS 66866-1117
(620) 983-2152
(620) 983-2281
Taxonomy
Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
100419260A
KS
261QA0600X
Adult Day Care Clinic/Center
100419260A
KS
314000000X
Skilled Nursing Facility
Primary
100107310A
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100107310A
—
KS
05
—
100419260A
—
KS
Enumeration date
10/04/2005
Last updated
03/30/2011
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