Provider Demographics
NPI:1194836163
Name:CITY OF STOCKTON
Entity Type:Organization
Organization Name:CITY OF STOCKTON
Other - Org Name:SOLOMON VALLEY MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CITY MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLAEGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-425-6703
Mailing Address - Street 1:315 S ASH ST
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:KS
Mailing Address - Zip Code:67669-2136
Mailing Address - Country:US
Mailing Address - Phone:785-425-6754
Mailing Address - Fax:785-425-6755
Practice Address - Street 1:315 S ASH ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:KS
Practice Address - Zip Code:67669-2136
Practice Address - Country:US
Practice Address - Phone:785-425-6754
Practice Address - Fax:785-425-6755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN082002313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100110720AMedicaid
KS17E637OtherMEDICAID NUMBER
KS001654OtherBCBSKS (SNF)
KS048199OtherBCBSKS (DME)
KS048199OtherBCBSKS (DME)