Provider Demographics
NPI:1669984639
Name:SALINA MCCALL ILF OPCO,LLC
Entity type:Organization
Organization Name:SALINA MCCALL ILF OPCO,LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/OPERATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RENA
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLEN
Authorized Official - Suffix:
Authorized Official - Credentials:OPERATOR
Authorized Official - Phone:785-825-8183
Mailing Address - Street 1:626 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-4105
Mailing Address - Country:US
Mailing Address - Phone:785-825-8183
Mailing Address - Fax:785-825-1608
Practice Address - Street 1:626 S 3RD ST
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-4105
Practice Address - Country:US
Practice Address - Phone:785-825-8183
Practice Address - Fax:785-825-1608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-31
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSB085009253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSB085009Medicaid
KS=========Medicaid