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General NPI Number Information
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NPI Number | 1780950089
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Entity Type | Organization
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Legal Business Name | ADRIEL SKILLED RESIDENTIAL & DAY LLC
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Dates
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Enumeration Date | 03/30/2012
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Last Update Date | 03/30/2012
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Provider Practice Location Address
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Address Line | 12225 S BLACKBOB RD APT 111P
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City | OLATHE
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State | KS
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Zip | 66062-6913
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Country | US
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Telephone | 913-732-2055
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Fax | 913-254-0550
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Provider Business Mailing Address
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Address Line | 501 E 125TH TER
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City | OLATHE
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State | KS
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Zip | 66061-2725
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Country | US
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Telephone | 913-768-7414
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Fax | 913-254-0550
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MS. DENISE LOUISE NICHOLS
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Credential | LICENSE PRACTICAL NU
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Telephone | 913-522-5791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number | K.S.A. 75-3307B
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License Number State | KS
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