Organization
PRIME HEALTHCARE SERVICES-PROVIDENCE, LLC
Active
Other names
Providence Medical Center
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTOPHER DOAN (CHIEF COMPLIANCE COUNSEL)
(909) 235-4307
Entity
Organization
Contact information
Practice address
8929 PARALLEL PKWY, KANSAS CITY, KS 66112-1689
(913) 596-3229
Mailing address
8929 PARALLEL PKWY, KANSAS CITY, KS 66112-1689
(913) 596-3229
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
N105013
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
H-105-003
HOSPITAL LICENSE
KS
Enumeration date
08/23/2016
Last updated
08/23/2016
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