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General NPI Number Information
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NPI Number | 1720214620
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Entity Type | Organization
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Legal Business Name | SENIOR CARE OF KANSAS LLC
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Dates
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Enumeration Date | 06/05/2009
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Last Update Date | 06/30/2009
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Provider Practice Location Address
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Address Line | 3690 W 112TH AVE UNIT 205
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City | WESTMINSTER
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State | CO
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Zip | 80031-2118
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Country | US
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Telephone | 720-887-4955
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Fax | 720-887-4955
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Provider Business Mailing Address
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Address Line | 3690 W 112TH AVE UNIT 205
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City | WESTMINSTER
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State | CO
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Zip | 80031-2118
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Country | US
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Telephone | 720-887-4955
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Fax | 720-887-4955
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Authorized Official
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Title or Position | OWNER
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Name | MR. ALAN DOUGLAS FARBER
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Credential |
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Telephone | 720-887-4955
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 115260
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 115260
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License Number State | CO
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