=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871373373
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SENIOR LIVING CAPITAL GROUP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/02/2023
-----------------------------------------------------
Last Update Date | 10/02/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2120 N 13TH ST
-----------------------------------------------------
City | INDEPENDENCE
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67301-2174
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 620-331-1400
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8080 N CENTRAL EXPY STE 1080
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75206-1864
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | REGIONAL MANAGER
-----------------------------------------------------
Name | JESSICA BAZE
-----------------------------------------------------
Credential | LPN
-----------------------------------------------------
Telephone | 620-786-2085
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------