MEDICARE: CPF SENIOR LIVING - HIAWATHA LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1356706998
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CPF SENIOR LIVING - HIAWATHA LLC

Provider Business Mailing Address
First Line	:	980 N MICHIGAN AVE
Second Line	:	SUITE 1998
City	:	CHICAGO
State	:	IL
Zip	:	60611-4501
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 KANSAS AVE
Second Line	:
City	:	HIAWATHA
State	:	KS
Zip	:	66434-1954
Country	:	US
Telephone Number	:	785-742-4566
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	JAY FLATT
Credential	:
Telephone Number	:	312-273-4750

Provider Enumeration Date	:	12/28/2015
Last Update Date	:	12/28/2015

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