Provider Demographics
NPI:1225161359
Name:MARIA COURT
Entity Type:Organization
Organization Name:MARIA COURT
Other - Org Name:VILLA MARIA, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:BALLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-777-9917
Mailing Address - Street 1:633 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MULVANE
Mailing Address - State:KS
Mailing Address - Zip Code:67110-1781
Mailing Address - Country:US
Mailing Address - Phone:316-777-9917
Mailing Address - Fax:
Practice Address - Street 1:633 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MULVANE
Practice Address - State:KS
Practice Address - Zip Code:67110-1781
Practice Address - Country:US
Practice Address - Phone:316-777-9917
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VILLA MARIA, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-14
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
310400000X
KSN096011311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSN096011OtherSTATE LICENSE
KS100109490BMedicaid