MEDICARE: THE GRESHAM LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1215684816
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE GRESHAM LLC

Provider Business Mailing Address
First Line	:	1730 N NORTHWEST PKWY
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67212-1548
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1730 N NORTHWEST PKWY
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67212-1548
Country	:	US
Telephone Number	:	316-252-3004
Fax Number	:

Authorized Official
Title or Position	:	OPERATOR
Name	:	JORDAN JADE FORD
Credential	:
Telephone Number	:	913-274-0740

Provider Enumeration Date	:	03/04/2022
Last Update Date	:	03/11/2026

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Directions to “THE GRESHAM LLC ” Practice Location

Language	Start Address	Practice Location

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