Healthcare Provider Details

I. General information

NPI: 1811027857
Provider Name (Legal Business Name): THE RESIDENCIES AT PLEASANTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 WEST 15TH STREET #418
PLEASANTON KS
66075-0418
US

IV. Provider business mailing address

706 W. 15TH ST. PO BOX 418
PLEASANTON KS
66075
US

V. Phone/Fax

Practice location:
  • Phone: 913-352-6658
  • Fax:
Mailing address:
  • Phone: 913-352-6658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberN054005
License Number StateKS

VIII. Authorized Official

Name: SHIRLENE JOHNSON
Title or Position: OPERATOR
Credential:
Phone: 913-352-6658