Provider Demographics
NPI:1184217358
Name:FSL KANSAS CITY TENANT LLC
Entity Type:Organization
Organization Name:FSL KANSAS CITY TENANT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROJECT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CRAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-877-1717
Mailing Address - Street 1:1240 E INDEPENDENCE ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-4201
Mailing Address - Country:US
Mailing Address - Phone:417-877-1717
Mailing Address - Fax:417-877-1818
Practice Address - Street 1:2300 N 113TH TER
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66109-3786
Practice Address - Country:US
Practice Address - Phone:913-400-7006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-02-18
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility