Basic Information
| Provider Information | |||||||||
| NPI: | 1508905738 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | KANSAS ASSISTED LIVING LLC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | CARRIAGE HOUSE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 723 S ELM ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBURG | ||||||||
| State: | KS | ||||||||
| PostalCode: | 670541910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3167762194 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 723 S ELM ST | ||||||||
| Address2: | |||||||||
| City: | GREENSBURG | ||||||||
| State: | KS | ||||||||
| PostalCode: | 670541910 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3167762194 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2007 | ||||||||
| LastUpdateDate: | 08/05/2008 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | UNREIN | ||||||||
| AuthorizedOfficialFirstName: | KEVIN | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 3167756333 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | N049003 | KS | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
No ID Information.