Provider Demographics
NPI:1972657468
Name:ATTICA HOSPITAL DISTRICT #1
Entity Type:Organization
Organization Name:ATTICA HOSPITAL DISTRICT #1
Other - Org Name:ATTICA LONG TERM CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD CHAIRMAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-254-7256
Mailing Address - Street 1:302 NORTH BOTKIN
Mailing Address - Street 2:
Mailing Address - City:ATTICA
Mailing Address - State:KS
Mailing Address - Zip Code:67009-9032
Mailing Address - Country:US
Mailing Address - Phone:620-254-7253
Mailing Address - Fax:620-254-7629
Practice Address - Street 1:302 NORTH BOTKIN
Practice Address - Street 2:
Practice Address - City:ATTICA
Practice Address - State:KS
Practice Address - Zip Code:67009-9032
Practice Address - Country:US
Practice Address - Phone:620-254-7253
Practice Address - Fax:620-254-7629
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-22
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN039003311ZA0620X
314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100107170AMedicaid