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General NPI Number Information
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NPI Number | 1811342280
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Entity Type | Organization
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Legal Business Name | HOMESTEAD OF CRESTVIEW OPERATIONS LLC
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Dates
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Enumeration Date | 05/04/2016
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Last Update Date | 05/04/2016
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Provider Practice Location Address
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Address Line | 600 N 127TH ST E
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City | WICHITA
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State | KS
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Zip | 67206-2807
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Country | US
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Telephone | 316-733-8100
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Fax |
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Provider Business Mailing Address
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Address Line | 3715 SW 29TH ST SUITE 200
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City | TOPEKA
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State | KS
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Zip | 66614-2107
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Country | US
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Telephone | 785-272-1535
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | MICHAEL D TRYON
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Credential |
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Telephone | 785-272-1535
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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 | N087059
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License Number State | KS
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