Provider Demographics
NPI:1487643359
Name:CITY OF HOWARD
Entity Type:Organization
Organization Name:CITY OF HOWARD
Other - Org Name:HOWARD TWILIGHT MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MAYOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-374-2202
Mailing Address - Street 1:849 E WASHINGTON
Mailing Address - Street 2:
Mailing Address - City:HOWARD
Mailing Address - State:KS
Mailing Address - Zip Code:67349-9418
Mailing Address - Country:US
Mailing Address - Phone:620-374-2495
Mailing Address - Fax:620-374-2098
Practice Address - Street 1:849 E WASHINGTON
Practice Address - Street 2:
Practice Address - City:HOWARD
Practice Address - State:KS
Practice Address - Zip Code:67349-9418
Practice Address - Country:US
Practice Address - Phone:620-374-2495
Practice Address - Fax:620-374-2098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2014-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSNO25002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100108630-AMedicaid
KS175436Medicare Oscar/Certification