MEDICARE: LEISURE HOMESTEAD ASSOCIATION

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	314000000X	Skilled Nursing Facility	N098001	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	17E607	OTHER	FEDERAL PROVIDER NO
3	161495	OTHER	AAHSA ID NO

General Provider Information

NPI Number	:	1326181066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEISURE HOMESTEAD ASSOCIATION

Provider Business Mailing Address
First Line	:	402 N SANTA FE ST
Second Line	:
City	:	SAINT JOHN
State	:	KS
Zip	:	67576-1800
Country	:	US
Telephone Number	:	620-549-3541
Fax Number	:	620-549-3590

Provider Business Practice Location Address
First Line	:	402 N SANTA FE ST
Second Line	:
City	:	SAINT JOHN
State	:	KS
Zip	:	67576-1800
Country	:	US
Telephone Number	:	620-549-3541
Fax Number	:	620-549-3590

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. JAMES SCOTT YOUNIE
Credential	:
Telephone Number	:	620-549-3541

Provider Enumeration Date	:	02/14/2007
Last Update Date	:	01/20/2022

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Directions to “LEISURE HOMESTEAD ASSOCIATION ” Practice Location

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