Provider Demographics
NPI:1497894463
Name:SA-ENC TONGANOXIE, LLC
Entity Type:Organization
Organization Name:SA-ENC TONGANOXIE, LLC
Other - Org Name:TONGANOXIE NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:ARI
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKENSON
Authorized Official - Suffix:
Authorized Official - Credentials:JD, MPH
Authorized Official - Phone:914-390-4366
Mailing Address - Street 1:44 S BROADWAY
Mailing Address - Street 2:SUITE 614
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10601-4425
Mailing Address - Country:US
Mailing Address - Phone:914-390-4366
Mailing Address - Fax:866-280-2653
Practice Address - Street 1:1010 EAST ST # 940
Practice Address - Street 2:
Practice Address - City:TONGANOXIE
Practice Address - State:KS
Practice Address - Zip Code:66086-9557
Practice Address - Country:US
Practice Address - Phone:913-369-8705
Practice Address - Fax:913-369-2787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN052005314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS175215Medicare Oscar/Certification