Provider Demographics
NPI:1285218172
Name:BICKFORD OF OVERLAND PARK OPCO, LLC
Entity Type:Organization
Organization Name:BICKFORD OF OVERLAND PARK OPCO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEGG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-782-3200
Mailing Address - Street 1:13795 S MUR LEN RD STE 301
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1096
Mailing Address - Country:US
Mailing Address - Phone:913-782-3200
Mailing Address - Fax:913-254-4802
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:913-642-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-07
Last Update Date:2021-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility