Great Bend-LTC, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

GREAT BEND-LTC, LLC

Practice address

1560 K 96 Hwy
Great Bend, KS 67530-3012

Phone

(678) 522-2436

Fax

(770) 663-4539

NPI assigned

Oct 25, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Daren G Douston

Title

Member Cfo

Phone

(678) 522-2436

Specialties & licenses 1

Addresses

Other names 1

• Great Bend Health & Rehabilitation Center Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1319500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1447286400000",
    "number": "1437435286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10945 STATE BRIDGE RD",
            "address_2": "SUITE 401-470",
            "city": "ALPHARETTA",
            "state": "GA",
            "postal_code": "300228164",
            "telephone_number": "678-522-2436",
            "fax_number": "770-663-4539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1560 K 96 HWY",
            "city": "GREAT BEND",
            "state": "KS",
            "postal_code": "675303012",
            "telephone_number": "678-522-2436",
            "fax_number": "770-663-4539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GREAT BEND-LTC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-25",
        "last_updated": "2015-11-12",
        "status": "A",
        "authorized_official_last_name": "DOUSTON",
        "authorized_official_first_name": "DAREN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "MEMBER CFO",
        "authorized_official_telephone_number": "678-522-2436"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Great Bend Health & Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• All providers in Great Bend, KS
• Skilled Nursing Facility in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 12, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.