Provider Demographics
NPI:1770940660
Name:STONEYBROOK RETIREMENT
Entity type:Organization
Organization Name:STONEYBROOK RETIREMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COTA
Authorized Official - Prefix:
Authorized Official - First Name:BRIDGET
Authorized Official - Middle Name:
Authorized Official - Last Name:BECHARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-776-0065
Mailing Address - Street 1:PO BOX 101
Mailing Address - Street 2:803 HICKORY
Mailing Address - City:WAKEFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67487-0101
Mailing Address - Country:US
Mailing Address - Phone:785-307-2762
Mailing Address - Fax:
Practice Address - Street 1:2025 LITTLE KITTEN AVE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503-7545
Practice Address - Country:US
Practice Address - Phone:785-776-0065
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-22
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS18-00788314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility