=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598924045
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNITED SENIOR PROPERTIES OF STERLING, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2008
-----------------------------------------------------
Last Update Date | 01/29/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2201 E LEFEVRE RD
-----------------------------------------------------
City | STERLING
-----------------------------------------------------
State | IL
-----------------------------------------------------
Zip | 61081-1603
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 815-626-5439
-----------------------------------------------------
Fax | 815-626-5686
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10501 W 84TH TER
-----------------------------------------------------
City | LENEXA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66214-1643
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 913-492-7800
-----------------------------------------------------
Fax | 913-492-7801
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEMBER
-----------------------------------------------------
Name | PAUL THOMA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 913-492-7800
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | 5100158
-----------------------------------------------------
License Number State | IL
-----------------------------------------------------