Healthcare Provider Details

I. General information

NPI: 1689931016
Provider Name (Legal Business Name): COVENANT PLACE OF LENEXA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2012
Last Update Date: 01/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8505 PFLUMM RD
LENEXA KS
66215-2461
US

IV. Provider business mailing address

11827 W 112TH ST SUITE 103
OVERLAND PARK KS
66210-2726
US

V. Phone/Fax

Practice location:
  • Phone: 913-307-2000
  • Fax: 913-322-0200
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: SCOTT E GULLEDGE
Title or Position: MANAGER
Credential:
Phone: 913-890-4782