Provider Demographics
NPI:1497815252
Name:MIDWEST HOMESTEAD OF OLATHE OPERATIONS, LLC
Entity Type:Organization
Organization Name:MIDWEST HOMESTEAD OF OLATHE OPERATIONS, LLC
Other - Org Name:HOMESTEAD OF OLATHE - NORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:TRYON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-272-1535
Mailing Address - Street 1:3715 SW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66614-2107
Mailing Address - Country:US
Mailing Address - Phone:785-272-1535
Mailing Address - Fax:785-440-0380
Practice Address - Street 1:791 N SOMERSET TER
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-5450
Practice Address - Country:US
Practice Address - Phone:913-829-1403
Practice Address - Fax:913-829-6182
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2013-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS200304040A310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200304040AMedicaid