Provider Demographics
NPI:1154319192
Name:MT HOPE COMMUNITY DEVELOPMENT INC
Entity Type:Organization
Organization Name:MT HOPE COMMUNITY DEVELOPMENT INC
Other - Org Name:MT HOPE NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAT
Authorized Official - Middle Name:J
Authorized Official - Last Name:KISSICK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:316-667-2431
Mailing Address - Street 1:704 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOPE
Mailing Address - State:KS
Mailing Address - Zip Code:67108-9408
Mailing Address - Country:US
Mailing Address - Phone:316-667-2431
Mailing Address - Fax:316-661-2352
Practice Address - Street 1:704 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MOUNT HOPE
Practice Address - State:KS
Practice Address - Zip Code:67108-9408
Practice Address - Country:US
Practice Address - Phone:316-667-2431
Practice Address - Fax:316-661-2352
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2009-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN087014314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100109180AMedicaid
KS100109180AMedicaid