Provider Demographics
NPI:1336685932
Name:ST ANTHONYS SENIOR CARE HOSPITAL, LLC
Entity Type:Organization
Organization Name:ST ANTHONYS SENIOR CARE HOSPITAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:KRUSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-448-0850
Mailing Address - Street 1:10300 W MAPLE ST STE 5
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-3135
Mailing Address - Country:US
Mailing Address - Phone:316-448-0850
Mailing Address - Fax:316-448-0855
Practice Address - Street 1:2114 N 127TH ST E
Practice Address - Street 2:SUITE 100
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206-3003
Practice Address - Country:US
Practice Address - Phone:316-500-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AXIOM GERI PSYCH SERVICES, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-06
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital