Provider Demographics
NPI:1083960553
Name:WINTER MEADOW HOMES
Entity type:Organization
Organization Name:WINTER MEADOW HOMES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:BENNIE
Authorized Official - Middle Name:NAE
Authorized Official - Last Name:BOXX
Authorized Official - Suffix:II
Authorized Official - Credentials:RN
Authorized Official - Phone:785-234-2989
Mailing Address - Street 1:2832 SW MULVANE ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66611-1626
Mailing Address - Country:US
Mailing Address - Phone:785-234-2989
Mailing Address - Fax:785-234-2979
Practice Address - Street 1:2832 SW MULVANE ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66611-1626
Practice Address - Country:US
Practice Address - Phone:785-234-2989
Practice Address - Fax:785-234-2979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-02
Last Update Date:2012-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSBO89070311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home