Provider Demographics
NPI:1912376567
Name:SALINA WINDSOR SNF OPCO, LLC
Entity Type:Organization
Organization Name:SALINA WINDSOR SNF OPCO, LLC
Other - Org Name:LEGACY AT SALINA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ISAAC
Authorized Official - Middle Name:
Authorized Official - Last Name:DOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-724-8950
Mailing Address - Street 1:1633 N CAMPBELL AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60647-5203
Mailing Address - Country:US
Mailing Address - Phone:312-724-8950
Mailing Address - Fax:
Practice Address - Street 1:623 S 3RD ST
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-4104
Practice Address - Country:US
Practice Address - Phone:785-825-6757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS175127Medicare Oscar/Certification