Organization
KANSAS MASONIC HOME, INC.
Active
Other names
Kansas Masonic Home Hospice
Organization subpart
No
Provider details
NPI number
Authorized official
TIM C NIKKEL (DIRECTOR OF FINANCE)
(316) 269-7652
Entity
Organization
Contact information
Practice address
401 S SENECA ST, WICHITA, KS 67213-5541
(316) 269-7652
(316) 267-2199
Mailing address
401 S SENECA ST, WICHITA, KS 67213-5541
(316) 269-7652
(316) 267-2199
Taxonomy
Speciality
Code
Description
License number
State
315D00000X
Inpatient Hospice
Primary
Z087011
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0578
BLUE CROSS-BLUE SHIELD
KS
Enumeration date
05/11/2007
Last updated
08/22/2020
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