The Nicol Home, Inc.
Organization Active NPI Skilled Nursing Facility · Glasco, KS
NPI 1104874973 · NPPES record last updated Sep 8, 2011
Key facts
- NPI
- 1104874973
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- N015004 (KS)
- Legal business name
- THE NICOL HOME, INC.
- Practice address
- 303 E Buffalo St
Glasco, KS 67445-9386 - Phone
- (785) 568-2251
- Fax
- (785) 568-2113
- NPI assigned
- May 4, 2006
- Organization subpart
- No
Authorized official
- Name
- Mr. Francis Tatro, ADM.
- Title
- Administrator
- Phone
- (785) 568-2251
Owners & managing parties with NPI records 1
Practitioners 1
-
Bal K Sharma, MD
Affiliated clinicians 4
-
Craig Alan Concannon, M.D.
-
Carl Lee Fugate, M.D.
Medicare Care Compare: Nursing home
- Listed as
- The Nicol Home
- Overall star rating
- ★★★★☆ 4 of 5
- Health inspections
- ★★★★★ 5 of 5
- Staffing
- ★★★☆☆ 3 of 5
- Quality measures
- ★☆☆☆☆ 1 of 5
- Type
- Medicare and Medicaid
- Ownership
- For profit - Corporation
- Certified
- Mar 1, 2004
- Medicare certification status
- Active
- Certified beds
- 32 · 26.2 residents per day on average
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 17D0648359 | Nicol Home Inc, the | Certificate of waiver | Aug 31, 2026 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KS
Skilled nursing facility certification: CCN 175473
- Legal name
- THE NICOL HOME, INC.
- Doing business as
- THE NICOL HOME
- Certification status
- Active
- Provider type (POS)
- Nursing home – SNF/NF dual certification
- Participating since
- Mar 1, 2004
- Last certification
- Jul 31, 2024
- Beds
- 32
- Ownership / control type
- Corporation
- Organization structure
- Corporation · Non-profit
- Enrollment address
- 303 E Buffalo Street
Glasco, KS 67445-9386 - Nursing home name
- THE NICOL HOME
All disclosed owners & managing parties 9
| Name | Role | Since | Share |
|---|---|---|---|
| Tracy J Travis |
Corporate Director |
Feb 21, 2024 | |
| Operational/Managerial Control | Feb 21, 2024 | ||
| Marvin Hanning |
Corporate Director |
Jan 1, 2011 | 10% |
| Operational/Managerial Control | Jan 1, 2011 | ||
| Michelle Wilson |
Corporate Director |
Feb 21, 2024 | |
| Operational/Managerial Control | Feb 21, 2024 | ||
| Patrick Gray |
Corporate Director |
Feb 21, 2024 | |
| Operational/Managerial Control | Feb 21, 2024 | ||
| Janice McClellan |
Corporate Director |
Jul 30, 2016 | |
| Operational/Managerial Control | Jul 30, 2016 | ||
| Carter Olson |
Corporate Officer |
Jul 1, 2018 | |
| Operational/Managerial Control |
Aug 18, 2018 | ||
| Adp of the SNF | Aug 18, 2018 | ||
| Michelle R Labes |
Corporate Director |
Feb 21, 2024 | |
| Operational/Managerial Control | Feb 21, 2024 | ||
| Eric S Anderson |
Adp of the SNF | Jan 1, 2024 | |
| David Melton |
Corporate Director |
Jan 1, 2021 | 10% |
| Operational/Managerial Control | Jan 1, 2021 |
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040217000670 | KS | Part a Provider - Skilled Nursing Facility | 0244125433 | Practice locations: Glasco, KS |
National Provider Directory
Locations
303 E Buffalo St
Glasco, KS 67445
Phone (785) 568-2251
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | N015004 | KS | Yes |
Addresses
Primary practice location
303 E Buffalo St
Glasco, KS 67445-9386
Mailing address
303 E Buffalo St
Glasco, KS 67445-9386
Phone (785) 568-2251
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1567 | Other | KS | BLUE CROSS BLUE SHIELD |
| 100108540A | Medicaid | KS |
Other providers in Glasco, KS
All providers in Glasco, KS · Skilled Nursing Facility in Kansas
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 8, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- CMS facility enrollments, All Owners and change-of-ownership files: CCNs, owners and managing parties.
- Provider of Services files (CMS): certification status, beds and related CCNs.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.