Provider Demographics
NPI:1295037869
Name:HERITAGE AVONLEA OF OLATHE LLC
Entity Type:Organization
Organization Name:HERITAGE AVONLEA OF OLATHE LLC
Other - Org Name:AVONLEA COTTAGE OF OLATHE OR UNITED SENIOR PROPERTIES OF OLATHE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHECHTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-233-1305
Mailing Address - Street 1:10024 SKOKIE BLVD SUITE 213
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60077
Mailing Address - Country:US
Mailing Address - Phone:224-233-1305
Mailing Address - Fax:224-233-1306
Practice Address - Street 1:625 N. LINCOLN ST.
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061
Practice Address - Country:US
Practice Address - Phone:913-829-6920
Practice Address - Fax:913-829-6993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN-046-035310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility