Provider Demographics
NPI:1972597029
Name:OTTAWA MEDICAL SERVICES, INC.
Entity Type:Organization
Organization Name:OTTAWA MEDICAL SERVICES, INC.
Other - Org Name:OTTAWA WEST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:F
Authorized Official - Last Name:RAUPACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-487-3600
Mailing Address - Street 1:330 STRAIGHT ST
Mailing Address - Street 2:SUITE 330
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-1064
Mailing Address - Country:US
Mailing Address - Phone:513-487-3600
Mailing Address - Fax:513-487-3612
Practice Address - Street 1:1527 S TWYMAN ST
Practice Address - Street 2:
Practice Address - City:OTTAWA
Practice Address - State:KS
Practice Address - Zip Code:66067-3478
Practice Address - Country:US
Practice Address - Phone:785-242-9378
Practice Address - Fax:785-242-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-06
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSNO30007310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSNO30007OtherADULT CARE HOME LICENSE