Provider Demographics
NPI:1164836540
Name:COMFORTCARE HOMES OF PITTSBURG LLC
Entity Type:Organization
Organization Name:COMFORTCARE HOMES OF PITTSBURG LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALISHIA
Authorized Official - Middle Name:
Authorized Official - Last Name:WINDSOR
Authorized Official - Suffix:
Authorized Official - Credentials:CNA,CMA,CDP, OPER
Authorized Official - Phone:620-308-6520
Mailing Address - Street 1:803 LAKEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-6149
Mailing Address - Country:US
Mailing Address - Phone:620-308-6520
Mailing Address - Fax:
Practice Address - Street 1:704 LAKEVIEW DR.
Practice Address - Street 2:704 LAKEVIEW DR.
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-6149
Practice Address - Country:US
Practice Address - Phone:620-308-6520
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS201089820A311500000X
311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201089820AMedicaid
KS201289820BMedicaid