Provider Demographics
NPI:1770675571
Name:K.J.,INC
Entity type:Organization
Organization Name:K.J.,INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:R
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:620-223-3120
Mailing Address - Street 1:PO BOX 831
Mailing Address - Street 2:
Mailing Address - City:FORT SCOTT
Mailing Address - State:KS
Mailing Address - Zip Code:66701-0831
Mailing Address - Country:US
Mailing Address - Phone:620-223-3120
Mailing Address - Fax:620-223-3884
Practice Address - Street 1:736 HEYLMAN ST
Practice Address - Street 2:
Practice Address - City:FORT SCOTT
Practice Address - State:KS
Practice Address - Zip Code:66701-2433
Practice Address - Country:US
Practice Address - Phone:620-223-3120
Practice Address - Fax:620-223-3884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN006004314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
175384Medicare ID - Type Unspecified