Kansas Masonic Home, Inc.

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

N087055 Issued in KS

Legal business name

KANSAS MASONIC HOME, INC.

Doing business as

Kansas Masonic Home

Practice address

401 S Seneca St
Wichita, KS 67213-5541

Phone

(316) 269-7500

Fax

(316) 267-2199

NPI assigned

Mar 13, 2007

Last updated

Aug 22, 2020By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Tim Nikkel

Title

Director of Finance

Phone

(316) 269-7652

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Kansas Masonic Home Doing business as

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1841323573",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 S SENECA ST",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672135541",
            "telephone_number": "316-269-7500",
            "fax_number": "316-267-2199"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 S SENECA ST",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672135541",
            "telephone_number": "316-269-7500",
            "fax_number": "316-267-2199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KANSAS MASONIC HOME, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "NIKKEL",
        "authorized_official_first_name": "TIM",
        "authorized_official_title_or_position": "DIRECTOR OF FINANCE",
        "authorized_official_telephone_number": "316-269-7652"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "KS",
            "license": "N087055",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10016680B",
            "state": "KS"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "N087055",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kansas Masonic Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Assisted Living Facility in Wichita, KS
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• Assisted Living Facility in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.