Organization
PROVIDENCE LIVING CENTER, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY L BARTLEY (CHIEF FINANCIAL OFFICER)
(785) 273-3383
Entity
Organization
Contact information
Practice address
1112 SE REPUBLICAN AVE, TOPEKA, KS 66607-1614
(785) 233-0588
(785) 233-5603
Mailing address
1112 SE REPUBLICAN AVE, TOPEKA, KS 66607-1614
(785) 233-0588
(785) 233-5603
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
N089003
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001359
BCBS
KS
Enumeration date
12/29/2005
Last updated
08/22/2020
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