Providence Living Center, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

N089003 Issued in KS

Legal business name

PROVIDENCE LIVING CENTER, INC.

Practice address

1112 SE Republican Ave
Topeka, KS 66607-1614

Phone

(785) 233-0588

Fax

(785) 233-5603

NPI assigned

Dec 29, 2005

Organization subpart

No

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

Authorized official

Name

Tracy L Bartley

Title

Chief Financial Officer

Phone

(785) 273-3383

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1135814400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1962489039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1112 SE REPUBLICAN AVE",
            "city": "TOPEKA",
            "state": "KS",
            "postal_code": "666071614",
            "telephone_number": "785-233-0588",
            "fax_number": "785-233-5603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1112 SE REPUBLICAN AVE",
            "city": "TOPEKA",
            "state": "KS",
            "postal_code": "666071614",
            "telephone_number": "785-233-0588",
            "fax_number": "785-233-5603"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVIDENCE LIVING CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-12-29",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "BARTLEY",
        "authorized_official_first_name": "TRACY",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "785-273-3383"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "KS",
            "license": "N089003",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "001359",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Brandon K Pruitt, MD
• Stacie Ardella Pruitt
• Gerard Joseph Pryor, APRN
• Gudrun Pryor, PHARMD

• Skilled Nursing Facility in Topeka, KS
• Providers in Topeka, KS by specialty
• Skilled Nursing 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.