Healthcare Provider Details

I. General information

NPI: 1447615083
Provider Name (Legal Business Name): CPF SENIOR LIVING - FREDONIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2015
Last Update Date: 12/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 E WASHINGTON ST
FREDONIA KS
66736-1757
US

IV. Provider business mailing address

980 N MICHIGAN AVE SUITE 1998
CHICAGO IL
60611-4501
US

V. Phone/Fax

Practice location:
  • Phone: 620-378-2329
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: JAY FLATT
Title or Position: CFO
Credential:
Phone: 312-273-4750