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General NPI Number Information
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NPI Number | 1740608660
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Entity Type | Organization
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Legal Business Name | UNITED SENIOR PROPERTIES OF SHAWNEE, LLC
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Dates
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Enumeration Date | 03/29/2014
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Last Update Date | 03/29/2014
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Provider Practice Location Address
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Address Line | 789 E COUNTRY GROVE DR
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City | SHAWNEE
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State | OK
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Zip | 74804-1404
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Country | US
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Telephone | 405-273-3323
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Fax |
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Provider Business Mailing Address
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Address Line | 789 E COUNTRY GROVE DR
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City | SHAWNEE
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State | OK
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Zip | 74804-1404
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Country | US
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Telephone | 405-273-3323
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | PAUL THOMA
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Credential |
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Telephone | 913-492-7800
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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 | AL6302
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License Number State | OK
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