Healthcare Provider Details

I. General information

NPI: 1679032361
Provider Name (Legal Business Name): ADBP GABLES OWNER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2019
Last Update Date: 03/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11701 NIEMAN RD
OVERLAND PARK KS
66210-4310
US

IV. Provider business mailing address

11701 NIEMAN RD
OVERLAND PARK KS
66210-4310
US

V. Phone/Fax

Practice location:
  • Phone: 913-345-1032
  • Fax:
Mailing address:
  • Phone: 913-345-1032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: NORMAN WILCOX
Title or Position: CEO
Credential:
Phone: 913-302-9206