Basic Information
| Provider Information | |||||||||
| NPI: | 1578117958 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BONNER SPRINGS LIVING, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1213 HYLTON HEIGHTS RD STE 129 | ||||||||
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| City: | MANHATTAN | ||||||||
| State: | KS | ||||||||
| PostalCode: | 665022812 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7857894750 | ||||||||
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| Practice Location | |||||||||
| Address1: | 520 E MORSE AVE | ||||||||
| Address2: | |||||||||
| City: | BONNER SPRINGS | ||||||||
| State: | KS | ||||||||
| PostalCode: | 660121911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9134412515 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/24/2019 | ||||||||
| LastUpdateDate: | 07/24/2019 | ||||||||
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| AuthorizedOfficialLastName: | NOVOTNY | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
| AuthorizedOfficialMiddleName: | MATTHEW | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 7857894750 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.