Provider Demographics
NPI:1144568189
Name:BUNYAN HOMES LLC
Entity Type:Organization
Organization Name:BUNYAN HOMES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDI
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-408-6550
Mailing Address - Street 1:1425 N STRATFORD LN
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-1139
Mailing Address - Country:US
Mailing Address - Phone:620-408-6550
Mailing Address - Fax:
Practice Address - Street 1:1425 N STRATFORD LN
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-1139
Practice Address - Country:US
Practice Address - Phone:620-408-6550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-25
Last Update Date:2013-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSB087184311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200742810AMedicaid