Provider Demographics
NPI:1265446041
Name:LEONARDVILLE NURSING HOME, INC
Entity type:Organization
Organization Name:LEONARDVILLE NURSING HOME, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADM. ASSIST.
Authorized Official - Prefix:MS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-293-5244
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:LEONARDVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66449-0148
Mailing Address - Country:US
Mailing Address - Phone:785-293-5244
Mailing Address - Fax:785-293-5574
Practice Address - Street 1:409 W BARTON RD
Practice Address - Street 2:
Practice Address - City:LEONARDVILLE
Practice Address - State:KS
Practice Address - Zip Code:66449-2023
Practice Address - Country:US
Practice Address - Phone:785-293-5244
Practice Address - Fax:785-293-5574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN-081-002314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100023180AOtherADULT DAY CARE
KS100108870AMedicaid
KS100023180AOtherADULT DAY CARE