Provider Demographics
NPI:1205010303
Name:FAMILY HEALTH AND REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:FAMILY HEALTH AND REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:FREDERICK
Authorized Official - Middle Name:
Authorized Official - Last Name:HERMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-425-5600
Mailing Address - Street 1:639 SOUTH MAIZE COURT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-1337
Mailing Address - Country:US
Mailing Address - Phone:316-425-5600
Mailing Address - Fax:316-425-8400
Practice Address - Street 1:639 SOUTH MAIZE COURT
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-1337
Practice Address - Country:US
Practice Address - Phone:316-425-5600
Practice Address - Fax:316-425-8400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN087061314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS175501Medicare Oscar/Certification