Provider Demographics
NPI:1598347817
Name:VIA CHRISTI VILLAGE GEORGETOWN
Entity Type:Organization
Organization Name:VIA CHRISTI VILLAGE GEORGETOWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-348-7621
Mailing Address - Street 1:1655 S GEORGETOWN ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-4140
Mailing Address - Country:US
Mailing Address - Phone:316-685-0400
Mailing Address - Fax:316-364-4401
Practice Address - Street 1:1655 S GEORGETOWN ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-4140
Practice Address - Country:US
Practice Address - Phone:316-685-0400
Practice Address - Fax:316-364-4401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-26
Last Update Date:2021-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSN087051OtherADULT CARE HOME