Healthcare Provider Details

I. General information

NPI: 1720214620
Provider Name (Legal Business Name): SENIOR CARE OF KANSAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2009
Last Update Date: 06/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3690 W 112TH AVE UNIT 205
WESTMINSTER CO
80031-2118
US

IV. Provider business mailing address

3690 W 112TH AVE UNIT 205
WESTMINSTER CO
80031-2118
US

V. Phone/Fax

Practice location:
  • Phone: 720-887-4955
  • Fax: 720-887-4955
Mailing address:
  • Phone: 720-887-4955
  • Fax: 720-887-4955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number115260
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number115260
License Number StateCO

VIII. Authorized Official

Name: MR. ALAN DOUGLAS FARBER
Title or Position: OWNER
Credential:
Phone: 720-887-4955