Provider Demographics
NPI:1851402275
Name:PRESBYTERIAN MANORS, INC.
Entity Type:Organization
Organization Name:PRESBYTERIAN MANORS, INC.
Other - Org Name:FORT SCOTT PRESBYTERIAN VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:WARD
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:316-685-1100
Mailing Address - Street 1:PO BOX 20440
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67208-1440
Mailing Address - Country:US
Mailing Address - Phone:316-685-1100
Mailing Address - Fax:316-685-2900
Practice Address - Street 1:2401 HORTON ST
Practice Address - Street 2:
Practice Address - City:FORT SCOTT
Practice Address - State:KS
Practice Address - Zip Code:66701-3178
Practice Address - Country:US
Practice Address - Phone:620-223-5550
Practice Address - Fax:620-223-7800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN/A310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS0963260014Medicare NSC