Healthcare Provider Details

I. General information

NPI: 1508905738
Provider Name (Legal Business Name): KANSAS ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2007
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 S ELM ST
GREENSBURG KS
67054-1910
US

IV. Provider business mailing address

723 S ELM ST
GREENSBURG KS
67054-1910
US

V. Phone/Fax

Practice location:
  • Phone: 316-776-2194
  • Fax:
Mailing address:
  • Phone: 316-776-2194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberN049003
License Number StateKS

VIII. Authorized Official

Name: MR. KEVIN L UNREIN
Title or Position: MEMBER
Credential:
Phone: 316-775-6333