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General NPI Number Information
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NPI Number | 1093258782
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Entity Type | Organization
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Legal Business Name | LAFAYETTE BICKFORD COTTAGE, LLC
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Dates
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Enumeration Date | 11/29/2016
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Last Update Date | 11/29/2016
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Provider Practice Location Address
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Address Line | 3633 REGAL VALLEY DR
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City | LAFAYETTE
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State | IN
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Zip | 47909-8383
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Country | US
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Telephone | 765-477-0770
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Fax | 765-477-0826
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Provider Business Mailing Address
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Address Line | 13795 S MUR LEN RD SUITE 301
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City | OLATHE
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State | KS
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Zip | 66062-1675
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Country | US
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Telephone | 913-782-3200
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Fax | 913-782-4851
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Authorized Official
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Title or Position | E
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Name | MR. ALAN FAIRBANKS
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Credential |
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Telephone | 913-782-3200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 16-004503-1
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License Number State | IN
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