Provider Demographics
NPI:1942304266
Name:PRESBYTERIAN MANORS, INC.
Entity Type:Organization
Organization Name:PRESBYTERIAN MANORS, INC.
Other - Org Name:PRESBYTERIAN HOSPICE OF MID-AMERICA
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:316-685-1100
Practice Address - Street 1:500 CAYCE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-2910
Practice Address - Country:US
Practice Address - Phone:573-756-7066
Practice Address - Fax:573-756-7991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-08
Last Update Date:2008-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO152-HO251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO261614Medicare Oscar/Certification