Organization
THE LEGACY AT PARK VIEW
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KIMBERLE B DOTY (ADMINISTRATOR)
(620) 356-3331
Entity
Organization
Contact information
Practice address
510 E SAN JACINTO AVE, ULYSSES, KS 67880-2241
(620) 356-3331
(620) 356-1932
Mailing address
510 E SAN JACINTO AVE, ULYSSES, KS 67880-2241
(620) 356-3331
(620) 356-1932
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
N034001
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100108710-B
—
KS
Enumeration date
10/03/2005
Last updated
10/10/2012
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