Provider Demographics
NPI:1316177959
Name:DERBY HEALTH & REHABILITATION
Entity Type:Organization
Organization Name:DERBY HEALTH & REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:HERMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-773-1313
Mailing Address - Street 1:7200 W 13TH ST N STE 10
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212-2968
Mailing Address - Country:US
Mailing Address - Phone:316-773-1313
Mailing Address - Fax:316-295-4379
Practice Address - Street 1:731 KLEIN CIR
Practice Address - Street 2:
Practice Address - City:DERBY
Practice Address - State:KS
Practice Address - Zip Code:67037-7011
Practice Address - Country:US
Practice Address - Phone:316-773-1313
Practice Address - Fax:316-295-4379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-16
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200637500AMedicaid
KS175514Medicare Oscar/Certification