Basic Information
Provider Information | |||||||||
NPI: | 1770929309 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | BUTLER SENIOR LIVING, LLC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | MAPLE SENIOR LIVING OF BUTLER | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 401 S 4TH ST STE 1900 | ||||||||
Address2: | ATTN: LEGAL DEPT. | ||||||||
City: | LOUISVILLE | ||||||||
State: | KY | ||||||||
PostalCode: | 402024436 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5057794700 | ||||||||
FaxNumber: | 5027794749 | ||||||||
Practice Location | |||||||||
Address1: | 300 S DELAWARE ST | ||||||||
Address2: |   | ||||||||
City: | BUTLER | ||||||||
State: | MO | ||||||||
PostalCode: | 647302014 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6606790866 | ||||||||
FaxNumber: | 6606790867 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/22/2013 | ||||||||
LastUpdateDate: | 05/22/2013 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | HUDSON | ||||||||
AuthorizedOfficialFirstName: | W. | ||||||||
AuthorizedOfficialMiddleName: | BRYABN | ||||||||
AuthorizedOfficialTitleorPosition: | EVP, GENERAL COUNSEL AND SECRETARY | ||||||||
AuthorizedOfficialTelephone: | 5027794700 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 310400000X | 041063 | MO | Y |   | Nursing & Custodial Care Facilities | Assisted Living Facility |   |
No ID Information.