Priscilla C Nelson – Adult Care Home Facility

Key facts

NPI: 1497979959
Entity type: Organization (NPI type 2)
Primary specialty: Adult Care Home Facility 311ZA0620X
License: B087145 (KS)
Legal business name: PRISCILLA C NELSON
Practice address: 1316 N Charlotte
Wichita, KS 67208
Phone: (316) 440-4406
Fax: (316) 440-4407
NPI assigned: Apr 13, 2007
Organization subpart: No

Authorized official

Name: Mrs. Priscilla Christine Bacci
Title: Owner
Phone: (316) 371-6563

National Provider Directory

Specialties & licenses

Specialty (taxonomy)	Code	License	State	Primary
Adult Care Home Facility	311ZA0620X	B087145	KS	Yes

Addresses

Primary practice location

1316 N Charlotte
Wichita, KS 67208

Mailing address

1842 Tara Falls CT
Wichita, KS 67207-6570
Phone (316) 440-4406

Other identifiers

Identifier	Type	State	Issuer
200400780A	Medicaid	KS
200543750A	Medicaid	KS

Other names

Bethel House Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jul 24, 2008.

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216857600000",
    "number": "1497979959",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1842 TARA FALLS CT",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672076570",
            "telephone_number": "316-440-4406",
            "fax_number": "316-201-1015"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1316 N CHARLOTTE",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "67208",
            "telephone_number": "316-440-4406",
            "fax_number": "316-440-4407"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRISCILLA C NELSON",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-13",
        "last_updated": "2008-07-24",
        "status": "A",
        "authorized_official_last_name": "BACCI",
        "authorized_official_first_name": "PRISCILLA",
        "authorized_official_middle_name": "CHRISTINE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "316-371-6563",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "311ZA0620X",
            "taxonomy_group": "",
            "desc": "Custodial Care Facility, Adult Care Home",
            "state": "KS",
            "license": "B087145",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200400780A",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200543750A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Bethel House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wichita, KS

All providers in Wichita, KS · Adult Care Home 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 Jul 24, 2008. Information in NPPES is self-reported and not verified by CMS.
NUCC Health Care Provider Taxonomy: specialty names.
National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.