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General NPI Number Information
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NPI Number | 1215684816
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Entity Type | Organization
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Legal Business Name | THE GRESHAM LLC
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Dates
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Enumeration Date | 03/04/2022
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Last Update Date | 03/04/2022
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Provider Practice Location Address
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Address Line | 1730 N NORTHWEST PKWY
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City | WICHITA
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State | KS
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Zip | 67212-1548
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Country | US
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Telephone | 316-252-3004
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Fax |
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Provider Business Mailing Address
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Address Line | 1400 TERRADYNE DR STE 316
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City | ANDOVER
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State | KS
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Zip | 67002-9264
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF ADMINISTRATIVE OFFICER
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Name | EMILEE GLATCZAK
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Credential |
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Telephone | 316-448-6287
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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 |
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License Number State |
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