Provider Demographics
NPI:1720011901
Name:MARKLEYSBURG HEALTHCARE INVESTORS, L.P.
Entity Type:Organization
Organization Name:MARKLEYSBURG HEALTHCARE INVESTORS, L.P.
Other - Org Name:WELLSVILLE MANOR CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:K
Authorized Official - Last Name:MITTLEIDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-619-0866
Mailing Address - Street 1:304 W 7TH ST
Mailing Address - Street 2:
Mailing Address - City:WELLSVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66092-7800
Mailing Address - Country:US
Mailing Address - Phone:785-883-4101
Mailing Address - Fax:785-883-2200
Practice Address - Street 1:304 W 7TH ST
Practice Address - Street 2:
Practice Address - City:WELLSVILLE
Practice Address - State:KS
Practice Address - Zip Code:66092-7800
Practice Address - Country:US
Practice Address - Phone:785-883-4101
Practice Address - Fax:785-883-2200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN030004314000000X
GA651332BN1400X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1042039101Medicaid
KS1044260001Medicare NSC
KS1042039101Medicaid