Provider Demographics
NPI:1366869547
Name:LIVING AT HOME LLC
Entity Type:Organization
Organization Name:LIVING AT HOME LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:DREES
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:620-271-8674
Mailing Address - Street 1:13610 N MENNONITE RD
Mailing Address - Street 2:
Mailing Address - City:GARDEN CITY
Mailing Address - State:KS
Mailing Address - Zip Code:67846-9144
Mailing Address - Country:US
Mailing Address - Phone:620-271-8674
Mailing Address - Fax:
Practice Address - Street 1:13610 N MENNONITE RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:KS
Practice Address - Zip Code:67846-9144
Practice Address - Country:US
Practice Address - Phone:620-271-8674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-25
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS11-00855225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty