Provider Demographics
NPI:1790783496
Name:WHEATLAND NURSING, LLC
Entity Type:Organization
Organization Name:WHEATLAND NURSING, LLC
Other - Org Name:WHEATLAND NURSING & REHAB CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:REIKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-471-1113
Mailing Address - Street 1:320 S LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:RUSSELL
Mailing Address - State:KS
Mailing Address - Zip Code:67665-2910
Mailing Address - Country:US
Mailing Address - Phone:785-483-5364
Mailing Address - Fax:785-483-4981
Practice Address - Street 1:320 S LINCOLN ST
Practice Address - Street 2:
Practice Address - City:RUSSELL
Practice Address - State:KS
Practice Address - Zip Code:67665-2910
Practice Address - Country:US
Practice Address - Phone:785-483-5364
Practice Address - Fax:785-483-4981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN084003314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0100111410Medicaid
KS0100111410Medicaid