MEDICARE: DELAWARE HIGHLANDS A.L. SERVICES PROVIDER

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	N105014	KS

General Provider Information

NPI Number	:	1235382961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DELAWARE HIGHLANDS A.L. SERVICES PROVIDER

Provider Business Mailing Address
First Line	:	12600 DELAWARE PKWY
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66109-8509
Country	:	US
Telephone Number	:	913-721-1400
Fax Number	:

Provider Business Practice Location Address
First Line	:	12600 DELAWARE PKWY
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66109-8509
Country	:	US
Telephone Number	:	913-721-1400
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	THOMAS W STIBAL
Credential	:
Telephone Number	:	913-279-3432

Provider Enumeration Date	:	10/28/2008
Last Update Date	:	10/28/2008

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