MEDICARE: CGAL 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	N064002	KS

General Provider Information

NPI Number	:	1306088315
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CGAL LLC

Provider Business Mailing Address
First Line	:	554 COUNTRY LN
Second Line	:
City	:	COUNCIL GROVE
State	:	KS
Zip	:	66846-1565
Country	:	US
Telephone Number	:	620-767-5600
Fax Number	:	620-767-6552

Provider Business Practice Location Address
First Line	:	554 COUNTRY LN
Second Line	:
City	:	COUNCIL GROVE
State	:	KS
Zip	:	66846-1565
Country	:	US
Telephone Number	:	620-767-5600
Fax Number	:	620-767-6552

Authorized Official
Title or Position	:	DIRECTOR
Name	:	SANDRA L. KLINE
Credential	:
Telephone Number	:	620-767-5600

Provider Enumeration Date	:	04/06/2009
Last Update Date	:	04/06/2009

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