Organization
CHENEY GOLDEN AGE HOME, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA MARTIN (ADMINISTRATOR)
(316) 540-3691
Entity
Organization
Contact information
Practice address
724 N MAIN ST, CHENEY, KS 67025-9059
(316) 540-3691
(316) 542-0165
Mailing address
PO BOX 370, CHENEY, KS 67025-0370
(316) 540-3691
(316) 542-0165
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
100108890A
KS
314000000X
Skilled Nursing Facility
Primary
100108890A
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100108890A
—
KS
Enumeration date
09/12/2005
Last updated
10/16/2024
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