Provider Demographics
NPI:1598863763
Name:MT JOSEPH SENIOR VILLAGE LLC
Entity Type:Organization
Organization Name:MT JOSEPH SENIOR VILLAGE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:G
Authorized Official - Last Name:CHAPMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-243-1347
Mailing Address - Street 1:1110 W 11TH ST
Mailing Address - Street 2:
Mailing Address - City:CONCORDIA
Mailing Address - State:KS
Mailing Address - Zip Code:66901-3902
Mailing Address - Country:US
Mailing Address - Phone:785-243-1347
Mailing Address - Fax:785-243-1907
Practice Address - Street 1:1110 W 11TH ST
Practice Address - Street 2:
Practice Address - City:CONCORDIA
Practice Address - State:KS
Practice Address - Zip Code:66901-3902
Practice Address - Country:US
Practice Address - Phone:785-243-1347
Practice Address - Fax:785-243-1907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN015003314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100108560AMedicaid
KS175420Medicare Oscar/Certification