Healthcare Provider Details

I. General information

NPI: 1659181154
Provider Name (Legal Business Name): NORTONVILLE ASSISTED LIVING, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2025
Last Update Date: 02/17/2025
Certification Date: 02/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 E WALNUT ST
NORTONVILLE KS
66060-4008
US

IV. Provider business mailing address

1869 CRAIG PARK CT
SAINT LOUIS MO
63146-4122
US

V. Phone/Fax

Practice location:
  • Phone: 913-886-6400
  • Fax: 913-886-8695
Mailing address:
  • Phone: 314-543-3816
  • Fax: 314-226-1736

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: RICHARD J. DESTEFANE
Title or Position: PRESIDENT
Credential:
Phone: 314-422-7910