Provider Demographics
NPI:1043841174
Name:SELAH HOME LLC
Entity Type:Organization
Organization Name:SELAH HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:NUSZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-841-2522
Mailing Address - Street 1:15328 SW 150TH ST
Mailing Address - Street 2:
Mailing Address - City:ROSE HILL
Mailing Address - State:KS
Mailing Address - Zip Code:67133-8003
Mailing Address - Country:US
Mailing Address - Phone:316-841-2522
Mailing Address - Fax:
Practice Address - Street 1:15834 SW BUTLER RD
Practice Address - Street 2:
Practice Address - City:ROSE HILL
Practice Address - State:KS
Practice Address - Zip Code:67133-8549
Practice Address - Country:US
Practice Address - Phone:316-841-2522
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home