Provider Demographics
NPI:1003362732
Name:MOC WICHITA, LLC
Entity Type:Organization
Organization Name:MOC WICHITA, LLC
Other - Org Name:THE HEALTHCARE RESORT OF WICHITA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:EZEKIEL
Authorized Official - Last Name:TURNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-460-0324
Mailing Address - Street 1:14300 CLAY TERRACE BLVD.
Mailing Address - Street 2:SUITE 257
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032
Mailing Address - Country:US
Mailing Address - Phone:317-582-6200
Mailing Address - Fax:
Practice Address - Street 1:7057 WEST VILLAGE CIRCLE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205
Practice Address - Country:US
Practice Address - Phone:316-977-7015
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MS OPERATING COMPANY, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-01
Last Update Date:2019-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility