Provider Demographics
NPI:1932109634
Name:MERIDIAN NURSING AND REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:MERIDIAN NURSING AND REHABILITATION CENTER, LLC
Other - Org Name:MERIDIAN REHABILITATION & HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:TUTERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-444-0900
Mailing Address - Street 1:1555 N MERIDIAN AVE
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-1942
Mailing Address - Country:US
Mailing Address - Phone:316-942-8471
Mailing Address - Fax:316-945-7682
Practice Address - Street 1:1555 N MERIDIAN AVE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-1942
Practice Address - Country:US
Practice Address - Phone:316-942-8471
Practice Address - Fax:316-945-7682
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN087003314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200329380AMedicaid
KS175274Medicare Oscar/Certification