Provider Demographics
NPI:1508848482
Name:LOUISBURG HEALTHCARE AND REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:LOUISBURG HEALTHCARE AND REHABILITATION CENTER, LLC
Other - Org Name:LOUISBURG HEALTHCARE AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-468-4752
Mailing Address - Street 1:1200 S. BROADWAY ST.
Mailing Address - Street 2:
Mailing Address - City:LOUISBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66053-3607
Mailing Address - Country:US
Mailing Address - Phone:913-837-2916
Mailing Address - Fax:913-837-5782
Practice Address - Street 1:1200 S. BROADWAY ST.
Practice Address - Street 2:
Practice Address - City:LOUISBURG
Practice Address - State:KS
Practice Address - Zip Code:66053-3607
Practice Address - Country:US
Practice Address - Phone:913-837-2916
Practice Address - Fax:913-837-5782
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-16
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN061006314000000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200304720AMedicaid
KS200304720AMedicaid