Provider Demographics
NPI:1093258782
Name:LAFAYETTE BICKFORD COTTAGE, LLC
Entity Type:Organization
Organization Name:LAFAYETTE BICKFORD COTTAGE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:E
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIRBANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-782-3200
Mailing Address - Street 1:13795 S MUR LEN RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1675
Mailing Address - Country:US
Mailing Address - Phone:913-782-3200
Mailing Address - Fax:913-782-4851
Practice Address - Street 1:3633 REGAL VALLEY DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-8383
Practice Address - Country:US
Practice Address - Phone:765-477-0770
Practice Address - Fax:765-477-0826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-29
Last Update Date:2016-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN16-004503-1310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility