Provider Demographics
NPI:1093146474
Name:GUEST HOME ESTATE OF IOLA, LLC
Entity Type:Organization
Organization Name:GUEST HOME ESTATE OF IOLA, LLC
Other - Org Name:GUEST HOME ESTATES V
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER/ MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:LAIDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-232-8323
Mailing Address - Street 1:1336 N WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:IOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66749-1601
Mailing Address - Country:US
Mailing Address - Phone:620-365-6989
Mailing Address - Fax:620-365-8118
Practice Address - Street 1:1336 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:IOLA
Practice Address - State:KS
Practice Address - Zip Code:66749-1601
Practice Address - Country:US
Practice Address - Phone:620-365-6989
Practice Address - Fax:620-365-8118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-10
Last Update Date:2013-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN001001CB310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200546870BMedicaid