Provider Demographics
NPI:1184876427
Name:AHG BLACKHAWK, LLC
Entity type:Organization
Organization Name:AHG BLACKHAWK, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:NORMAN
Authorized Official - Middle Name:GUY
Authorized Official - Last Name:WILCOX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-592-5101
Mailing Address - Street 1:22550 S FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:KS
Mailing Address - Zip Code:66083-8763
Mailing Address - Country:US
Mailing Address - Phone:913-592-5101
Mailing Address - Fax:913-307-0196
Practice Address - Street 1:22550 S FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:KS
Practice Address - Zip Code:66083-8763
Practice Address - Country:US
Practice Address - Phone:913-592-5101
Practice Address - Fax:913-307-0196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-17
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN046066310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility