Basic Information
| Provider Information | |||||||||
| NPI: | 1588721351 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BROOKDALE SENIOR LIVING COMMUNITIES, INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | BROOKDALE SALINA FAIRDALE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2251 E CRAWFORD ST | ||||||||
| Address2: | |||||||||
| City: | SALINA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 674011317 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858238600 | ||||||||
| FaxNumber: | 7858237031 | ||||||||
| Practice Location | |||||||||
| Address1: | 2251 E. CRAWFORD | ||||||||
| Address2: | |||||||||
| City: | SALINA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 67401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7858238600 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/02/2007 | ||||||||
| LastUpdateDate: | 12/03/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | LESKOWICZ | ||||||||
| AuthorizedOfficialFirstName: | JOANNE | ||||||||
| AuthorizedOfficialMiddleName: | K | ||||||||
| AuthorizedOfficialTitleorPosition: | SENIOR VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4149185000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BROOKDALE SENIOR LIVING INC | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 12/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | Y | Nursing & Custodial Care Facilities | Assisted Living Facility |
ID Information
| ID | Type | State | Issuer | Description | 100382540 I | 05 | KS | MEDICAID |