Provider Demographics
NPI:1619185345
Name:JEWELL HEALTH CARE, LLC
Entity Type:Organization
Organization Name:JEWELL HEALTH CARE, LLC
Other - Org Name:CHEYENNE MEADOWS LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REGISTERED AGENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:LARSON
Authorized Official - Suffix:
Authorized Official - Credentials:ATTORNEY
Authorized Official - Phone:816-322-8113
Mailing Address - Street 1:12120 STATE LINE RD # 372
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66209-1254
Mailing Address - Country:US
Mailing Address - Phone:816-322-8113
Mailing Address - Fax:816-322-6671
Practice Address - Street 1:272 W CHEYENNE ST
Practice Address - Street 2:
Practice Address - City:HOISINGTON
Practice Address - State:KS
Practice Address - Zip Code:67544-1576
Practice Address - Country:US
Practice Address - Phone:620-653-4141
Practice Address - Fax:620-653-4282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN0050033140N1450X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0000000771OtherBCBS PROVIDER NUMBER
KS0000000771OtherBCBS PROVIDER NUMBER