Provider Demographics
NPI:1831223270
Name:SHEPHERD OF THE PLAINS FOUNDATION
Entity type:Organization
Organization Name:SHEPHERD OF THE PLAINS FOUNDATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BRYANT
Authorized Official - Suffix:
Authorized Official - Credentials:RN ADMINISTRATOR
Authorized Official - Phone:620-855-3498
Mailing Address - Street 1:706 N. MAIN
Mailing Address - Street 2:P.O. BOX 249
Mailing Address - City:CIMARRON
Mailing Address - State:KS
Mailing Address - Zip Code:67835-0249
Mailing Address - Country:US
Mailing Address - Phone:620-855-3498
Mailing Address - Fax:620-855-2381
Practice Address - Street 1:706 N. MAIN
Practice Address - Street 2:
Practice Address - City:CIMARRON
Practice Address - State:KS
Practice Address - Zip Code:67835-0249
Practice Address - Country:US
Practice Address - Phone:620-855-3498
Practice Address - Fax:620-855-2381
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2012-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSNO35002313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100109530AMedicaid
KSPENDINGMedicare Oscar/Certification