Provider Demographics
NPI:1083634919
Name:AUSTIN INC.
Entity Type:Organization
Organization Name:AUSTIN INC.
Other - Org Name:EVENTIDE CONVALESCENT CENTER INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:M.
Authorized Official - Middle Name:MAC
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-233-8918
Mailing Address - Street 1:2015 SE 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66607-1615
Mailing Address - Country:US
Mailing Address - Phone:785-233-8918
Mailing Address - Fax:785-233-4212
Practice Address - Street 1:2015 SE 10TH AVE
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66607-1615
Practice Address - Country:US
Practice Address - Phone:785-233-8918
Practice Address - Fax:785-233-4212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2013-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN089004314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100107610AMedicaid
KS0194230001Medicare NSC
KS175113Medicare Oscar/Certification