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General NPI Number Information
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NPI Number | 1275078065
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Entity Type | Organization
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Legal Business Name | HOMESTEAD OF EL DORADO OPERATIONS LLC
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Dates
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Enumeration Date | 01/03/2017
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Last Update Date | 01/03/2017
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Provider Practice Location Address
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Address Line | 1650 E 12TH AVE
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City | EL DORADO
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State | KS
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Zip | 67042-4300
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Country | US
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Telephone | 316-321-7777
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Fax | 316-321-6115
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Provider Business Mailing Address
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Address Line | 1650 E 12TH AVE
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City | EL DORADO
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State | KS
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Zip | 67042-4300
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Country | US
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Telephone | 316-321-7777
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Fax | 316-321-6115
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Authorized Official
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Title or Position | CFO
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Name | MICHAEL D TRYON
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Credential | CPA
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Telephone | 785-272-1535
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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 | N008009
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License Number State | KS
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