Provider Demographics
NPI:1265674378
Name:BICKFORD OF OVERLAND PARK, LLC
Entity Type:Organization
Organization Name:BICKFORD OF OVERLAND PARK, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP/CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:EBY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-782-3200
Mailing Address - Street 1:10665 BARKLEY ST
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-1848
Mailing Address - Country:US
Mailing Address - Phone:913-782-3200
Mailing Address - Fax:913-782-4851
Practice Address - Street 1:10665 BARKLEY ST
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66212-1848
Practice Address - Country:US
Practice Address - Phone:913-782-3200
Practice Address - Fax:913-782-4851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-03
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN046050310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility