Healthcare Provider Details

I. General information

NPI: 1316908163
Provider Name (Legal Business Name): VILLAGE SHALOM, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 01/28/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 W 123RD ST
OVERLAND PARK KS
66209-3193
US

IV. Provider business mailing address

5500 W 123RD ST
OVERLAND PARK KS
66209-3193
US

V. Phone/Fax

Practice location:
  • Phone: 913-317-2600
  • Fax:
Mailing address:
  • Phone: 913-317-2600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberN046054
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberN046054
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License NumberN046054
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberN046054
License Number StateKS

VIII. Authorized Official

Name: MR. MATTHEW EARL LEWIS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 913-266-8400