Provider Demographics
NPI:1508874546
Name:SHILOH MANOR OF KANS
Entity Type:Organization
Organization Name:SHILOH MANOR OF KANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MGR
Authorized Official - Prefix:
Authorized Official - First Name:CASSIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:BRITTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-628-4403
Mailing Address - Street 1:BOX 67
Mailing Address - Street 2:601 SO KANSAS AVE
Mailing Address - City:CANTON
Mailing Address - State:KS
Mailing Address - Zip Code:67428
Mailing Address - Country:US
Mailing Address - Phone:620-628-4403
Mailing Address - Fax:620-628-5044
Practice Address - Street 1:601 SO KANSAS AVE
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:KS
Practice Address - Zip Code:67428
Practice Address - Country:US
Practice Address - Phone:620-628-4403
Practice Address - Fax:620-628-5044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS175453Medicare ID - Type Unspecified