Provider Demographics
NPI:1720561541
Name:MEDICALODGES, INC.
Entity Type:Organization
Organization Name:MEDICALODGES, INC.
Other - Org Name:GRAN VILLAS GREAT BEND
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-709-0305
Mailing Address - Street 1:1401 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-3152
Mailing Address - Country:US
Mailing Address - Phone:620-792-2165
Mailing Address - Fax:620-793-6341
Practice Address - Street 1:1401 CHERRY LN
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-3152
Practice Address - Country:US
Practice Address - Phone:620-792-2165
Practice Address - Fax:620-793-6341
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility