Provider Demographics
NPI:1710971858
Name:OTTAWA RETIREMENT PLAZA, INC.
Entity Type:Organization
Organization Name:OTTAWA RETIREMENT PLAZA, INC.
Other - Org Name:OTTAWA PLAZA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:F
Authorized Official - Last Name:RAUPACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-487-3600
Mailing Address - Street 1:330 STRAIGHT ST
Mailing Address - Street 2:SUITE 330
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-1064
Mailing Address - Country:US
Mailing Address - Phone:513-487-3600
Mailing Address - Fax:513-487-3612
Practice Address - Street 1:1042 W 15TH ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-3951
Practice Address - Country:US
Practice Address - Phone:785-242-1127
Practice Address - Fax:785-242-1536
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSNO3006251E00000X, 261QA0600X, 310400000X, 332B00000X, 3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No251E00000XAgenciesHome HealthGroup - Single Specialty
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3747P1801XNursing Service Related ProvidersTechnicianPersonal Care AttendantGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100019200AMedicaid
KSNO3006OtherADULT CARE HOME LICENSE