Healthcare Provider Details

I. General information

NPI: 1316356538
Provider Name (Legal Business Name): DELMAR GARDENS OF LENEXA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/13/2014
Last Update Date: 08/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9705 MONROVIA ST
LENEXA KS
66215-1500
US

IV. Provider business mailing address

14805 N OUTER 40 RD SUITE 300
CHESTERFIELD MO
63017-6060
US

V. Phone/Fax

Practice location:
  • Phone: 913-492-1133
  • Fax: 913-492-1427
Mailing address:
  • Phone: 636-733-7000
  • Fax: 636-733-7010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberN046078
License Number StateKS

VIII. Authorized Official

Name: MR. GAIL LEE HARTMANN
Title or Position: TREASURER
Credential:
Phone: 636-733-7000