Healthcare Provider Details

I. General information

NPI: 1609936459
Provider Name (Legal Business Name): MIDWEST HOMESTEAD OF LENEXA OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 09/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8740 CAENEN LAKE RD
LENEXA KS
66215-2069
US

IV. Provider business mailing address

3715 SW 29TH ST
TOPEKA KS
66614-2107
US

V. Phone/Fax

Practice location:
  • Phone: 913-894-0014
  • Fax: 913-894-4147
Mailing address:
  • Phone: 785-272-1535
  • Fax: 785-272-1480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number200303670A
License Number StateKS

VIII. Authorized Official

Name: MR. MICHAEL D TRYON
Title or Position: CFO
Credential:
Phone: 785-272-1535