Provider Demographics
NPI:1982699062
Name:WINFIELD REST HAVEN INC
Entity Type:Organization
Organization Name:WINFIELD REST HAVEN INC
Other - Org Name:WINFIELD REST HAVEN II, LC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:OLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:UTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-221-9290
Mailing Address - Street 1:1611 RITCHIE ST
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-5252
Mailing Address - Country:US
Mailing Address - Phone:620-221-9290
Mailing Address - Fax:620-229-8297
Practice Address - Street 1:1611 RITCHIE ST
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-5252
Practice Address - Country:US
Practice Address - Phone:620-221-9290
Practice Address - Fax:620-229-8297
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2012-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1042141001314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1042141001Medicaid
KS1042141001Medicaid