Provider Demographics
NPI:1295037828
Name:ALDERSGATE VILLAGE HOME HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:ALDERSGATE VILLAGE HOME HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:NEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-478-9440
Mailing Address - Street 1:7220 SW ASBURY DR
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-4706
Mailing Address - Country:US
Mailing Address - Phone:785-286-7474
Mailing Address - Fax:785-478-1726
Practice Address - Street 1:7220 SW ASBURY DR
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66614-4706
Practice Address - Country:US
Practice Address - Phone:785-286-7474
Practice Address - Fax:785-478-1726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSA-089-008251J00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSA-089-008OtherLICENSED HOME HEALTH AGENCY BY THE STATE OF KANSAS