Provider Demographics
NPI:1962482646
Name:RICHMOND HEALTHCARE AND REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:RICHMOND HEALTHCARE AND REHABILITATION CENTER, LLC
Other - Org Name:RICHMOND HEALTHCARE AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-468-4752
Mailing Address - Street 1:340 SOUTH STREET
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KS
Mailing Address - Zip Code:66080
Mailing Address - Country:US
Mailing Address - Phone:785-835-6135
Mailing Address - Fax:785-835-6179
Practice Address - Street 1:340 SOUTH STREET
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KS
Practice Address - Zip Code:66080
Practice Address - Country:US
Practice Address - Phone:785-835-6135
Practice Address - Fax:785-835-6179
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-01-19
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN030003314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200304700AMedicaid
KS200304700AMedicaid