Provider Demographics
NPI:1538123484
Name:MANASSEH HEALTH LLC
Entity Type:Organization
Organization Name:MANASSEH HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR OF LLC
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:GULLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-485-5164
Mailing Address - Street 1:808 N 8TH ST
Mailing Address - Street 2:
Mailing Address - City:SENECA
Mailing Address - State:KS
Mailing Address - Zip Code:66538-1419
Mailing Address - Country:US
Mailing Address - Phone:785-336-2156
Mailing Address - Fax:785-336-3881
Practice Address - Street 1:808 N 8TH ST
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:KS
Practice Address - Zip Code:66538-1419
Practice Address - Country:US
Practice Address - Phone:785-336-2156
Practice Address - Fax:785-336-3881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-15
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN066-003314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100445610AMedicaid
KS175426Medicare Oscar/Certification