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General NPI Number Information
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NPI Number | 1235253642
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Entity Type | Organization
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Legal Business Name | ASBURY VILLAGE
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3800 ASBURY DR
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City | COFFEYVILLE
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State | KS
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Zip | 67337-9153
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Country | US
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Telephone | 620-251-6270
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Fax |
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Provider Business Mailing Address
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Address Line | 3800 ASBURY DR
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City | COFFEYVILLE
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State | KS
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Zip | 67337-9153
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Country | US
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Telephone | 620-251-6270
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE ASSISTANT
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Name | MANDY L FARROW
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Credential |
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Telephone | 316-616-6218
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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 | N063012
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License Number State | KS
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