Provider Demographics
NPI:1427396118
Name:SHANK HOME LLC
Entity Type:Organization
Organization Name:SHANK HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:TUBBS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-353-5351
Mailing Address - Street 1:111 W RAILROAD AVE
Mailing Address - Street 2:PO BOX A
Mailing Address - City:LAKIN
Mailing Address - State:KS
Mailing Address - Zip Code:67860-6040
Mailing Address - Country:US
Mailing Address - Phone:620-355-6803
Mailing Address - Fax:620-355-6215
Practice Address - Street 1:111 W RAILROAD AVE
Practice Address - Street 2:PO BOX A
Practice Address - City:LAKIN
Practice Address - State:KS
Practice Address - Zip Code:67860-6040
Practice Address - Country:US
Practice Address - Phone:620-355-6803
Practice Address - Fax:620-355-6215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-30
Last Update Date:2013-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSB047001311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200677620AMedicaid