Provider Demographics
NPI:1033251962
Name:MILTONVALE MANOR , INC.
Entity Type:Organization
Organization Name:MILTONVALE MANOR , INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DICK
Authorized Official - Middle Name:
Authorized Official - Last Name:PHELPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-427-2466
Mailing Address - Street 1:100 WEST SPRUCE
Mailing Address - Street 2:
Mailing Address - City:MILTONVALE
Mailing Address - State:KS
Mailing Address - Zip Code:67466
Mailing Address - Country:US
Mailing Address - Phone:785-427-2466
Mailing Address - Fax:
Practice Address - Street 1:100 WEST SPRUCE
Practice Address - Street 2:
Practice Address - City:MILTONVALE
Practice Address - State:KS
Practice Address - Zip Code:67466
Practice Address - Country:US
Practice Address - Phone:785-427-2466
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility