Provider Demographics
NPI:1700981511
Name:SANDPIPER BAY HEALTH CENTER LLC
Entity Type:Organization
Organization Name:SANDPIPER BAY HEALTH CENTER LLC
Other - Org Name:SANDPIPER BAY HEALTH AND RETIREMENT CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:REDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-415-9700
Mailing Address - Street 1:5808 W. 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67212
Mailing Address - Country:US
Mailing Address - Phone:316-945-3606
Mailing Address - Fax:316-260-9544
Practice Address - Street 1:5808 W. 8TH STREET
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212
Practice Address - Country:US
Practice Address - Phone:316-945-3606
Practice Address - Fax:316-260-9544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS175344Medicare ID - Type UnspecifiedCURRENT MEDICARE NUMBER