Provider Demographics
NPI:1043429244
Name:CRAWFORD COUNTY ASSISTED LIVING
Entity Type:Organization
Organization Name:CRAWFORD COUNTY ASSISTED LIVING
Other - Org Name:WESTRIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-724-6760
Mailing Address - Street 1:950 W SAINT JOHN ST
Mailing Address - Street 2:
Mailing Address - City:GIRARD
Mailing Address - State:KS
Mailing Address - Zip Code:66743-2049
Mailing Address - Country:US
Mailing Address - Phone:620-724-6760
Mailing Address - Fax:
Practice Address - Street 1:950 W SAINT JOHN ST
Practice Address - Street 2:
Practice Address - City:GIRARD
Practice Address - State:KS
Practice Address - Zip Code:66743-2049
Practice Address - Country:US
Practice Address - Phone:620-724-6760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN019011310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility