Provider Demographics
NPI:1417002429
Name:EAGLECREST LLC
Entity Type:Organization
Organization Name:EAGLECREST LLC
Other - Org Name:EAGLECREST RETIREMENT COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:O'GORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:785-309-1501
Mailing Address - Street 1:1501 E MAGNOLIA RD
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-9112
Mailing Address - Country:US
Mailing Address - Phone:785-309-1501
Mailing Address - Fax:785-309-1502
Practice Address - Street 1:1501 E MAGNOLIA RD
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-9112
Practice Address - Country:US
Practice Address - Phone:785-309-1501
Practice Address - Fax:785-309-1502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN085012310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility