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General NPI Number Information
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NPI Number | 1295975936
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Entity Type | Organization
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Legal Business Name | CHERRY CREEK SENIOR CARE, LLC
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Dates
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Enumeration Date | 02/20/2009
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Last Update Date | 02/20/2009
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Provider Practice Location Address
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Address Line | 8200 E PAWNEE ST
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City | WICHITA
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State | KS
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Zip | 67207-5448
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Country | US
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Telephone | 316-684-0905
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 906 D
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City | ANDOVER
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State | KS
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Zip | 67002-0906
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Country | US
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Telephone | 316-733-2645
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Fax | 316-733-0995
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Authorized Official
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Title or Position | ACCOUNTING MANGER
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Name | ANDREA LAW
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Credential |
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Telephone | 316-733-2645
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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 | N087043
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License Number State | KS
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