Provider Demographics
NPI:1942699368
Name:WB REAL ESTATE OF IOLA, LLC
Entity Type:Organization
Organization Name:WB REAL ESTATE OF IOLA, LLC
Other - Org Name:GREYSTONE RESIDENTIAL CARE COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:WILCOX-BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-898-1079
Mailing Address - Street 1:2620 N KENTUCKY ST
Mailing Address - Street 2:
Mailing Address - City:IOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66749-1940
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2620 N KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:KS
Practice Address - Zip Code:66749-1940
Practice Address - Country:US
Practice Address - Phone:620-365-6002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201110780AMedicaid