Basic Information
| Provider Information | |||||||||
| NPI: | 1295975936 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CHERRY CREEK SENIOR CARE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | CARRINGTON AT CHERRY CREEK | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 906 | ||||||||
| Address2: | D | ||||||||
| City: | ANDOVER | ||||||||
| State: | KS | ||||||||
| PostalCode: | 670020906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3167332645 | ||||||||
| FaxNumber: | 3167330995 | ||||||||
| Practice Location | |||||||||
| Address1: | 8200 E PAWNEE ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672075448 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166840905 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2009 | ||||||||
| LastUpdateDate: | 02/20/2009 | ||||||||
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| AuthorizedOfficialLastName: | LAW | ||||||||
| AuthorizedOfficialFirstName: | ANDREA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ACCOUNTING MANGER | ||||||||
| AuthorizedOfficialTelephone: | 3167332645 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | N087043 | KS | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.