Provider Demographics
NPI:1861500860
Name:MANOR OF GARNETT, INC
Entity Type:Organization
Organization Name:MANOR OF GARNETT, INC
Other - Org Name:GOLDEN HEIGHTS LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACK
Authorized Official - Middle Name:DEAN
Authorized Official - Last Name:VETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-895-3932
Mailing Address - Street 1:101 N PINE ST
Mailing Address - Street 2:
Mailing Address - City:GARNETT
Mailing Address - State:KS
Mailing Address - Zip Code:66032-1134
Mailing Address - Country:US
Mailing Address - Phone:785-448-2434
Mailing Address - Fax:785-448-6524
Practice Address - Street 1:101 N PINE ST
Practice Address - Street 2:
Practice Address - City:GARNETT
Practice Address - State:KS
Practice Address - Zip Code:66032-1134
Practice Address - Country:US
Practice Address - Phone:785-448-2434
Practice Address - Fax:785-448-6524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN002002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100111760AMedicaid
KS0454600001Medicare NSC
KS175433Medicare ID - Type UnspecifiedMEDICARE
KS17D0878809Medicare ID - Type UnspecifiedMEDICARE CLIA WAIVER