Provider Demographics
NPI:1093104911
Name:PRESBYTERIAN MANORS, INC.
Entity Type:Organization
Organization Name:PRESBYTERIAN MANORS, INC.
Other - Org Name:SENIOR INDEPENDENCE HOSPICE OF MID-AMERICA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:H
Authorized Official - Last Name:SHOGREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-685-1111
Mailing Address - Street 1:PO BOX 20440
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-1440
Mailing Address - Country:US
Mailing Address - Phone:316-685-1111
Mailing Address - Fax:316-685-2900
Practice Address - Street 1:2414 N WOODLAWN BLVD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-3958
Practice Address - Country:US
Practice Address - Phone:316-685-1111
Practice Address - Fax:316-685-2900
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRESBYTERIAN MANORS, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-01-15
Last Update Date:2015-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based