Organization
MAIZE CCRC, LLC
Active
Parent organization
JUPITER TENANT, LLC
Other names
Park West Plaza
Organization subpart
Yes
Provider details
NPI number
Legal business name
JUPITER TENANT, LLC
Authorized official
MR. CHRISTOPHER WETTIG (CFO)
(316) 616-6288
Entity
Organization
Contact information
Practice address
505 N MAIZE RD, WICHITA, KS 67212-4689
(316) 729-4114
Mailing address
8415 E 21ST ST N STE 100, WICHITA, KS 67206-2959
(316) 616-6288
(316) 616-6255
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
Primary
N087046
KS
Other
Enumeration date
06/07/2013
Last updated
06/07/2013
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