Provider Demographics
NPI:1376890491
Name:WELLSVILLE RETIREMENT COMMUNITY
Entity Type:Organization
Organization Name:WELLSVILLE RETIREMENT COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REHAB DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:CHRISTOPHER
Authorized Official - Last Name:HURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:CPTA
Authorized Official - Phone:785-883-4101
Mailing Address - Street 1:304 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66092-7800
Mailing Address - Country:US
Mailing Address - Phone:785-883-4101
Mailing Address - Fax:785-883-2200
Practice Address - Street 1:304 W 7TH ST
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:KS
Practice Address - Zip Code:66092-7800
Practice Address - Country:US
Practice Address - Phone:785-883-4101
Practice Address - Fax:785-883-2200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS14-01971314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility