Provider Demographics
NPI:1477685162
Name:PHILLIPS COUNTY RETIREMENT CORPORATION
Entity Type:Organization
Organization Name:PHILLIPS COUNTY RETIREMENT CORPORATION
Other - Org Name:PHILLIPS COUNTY RETIREMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:KUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-543-2131
Mailing Address - Street 1:1300 STATE STREET
Mailing Address - Street 2:P.O. BOX 628
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:67661
Mailing Address - Country:US
Mailing Address - Phone:785-543-2131
Mailing Address - Fax:785-543-5200
Practice Address - Street 1:1300 STATE STREET
Practice Address - Street 2:
Practice Address - City:PHILLIPSBURG
Practice Address - State:KS
Practice Address - Zip Code:67661
Practice Address - Country:US
Practice Address - Phone:785-543-2131
Practice Address - Fax:785-543-5200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN074003313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110111750AMedicaid
KSN074003OtherSTATE I.D.