Provider Demographics
NPI:1538292792
Name:GUEST HOME ESTATES II
Entity Type:Organization
Organization Name:GUEST HOME ESTATES II
Other - Org Name:LIGHTNING CREEK INVESTMENT GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:ANNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:EMERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-431-9509
Mailing Address - Street 1:1202 S PLUMMER AVE
Mailing Address - Street 2:
Mailing Address - City:CHANUTE
Mailing Address - State:KS
Mailing Address - Zip Code:66720-2512
Mailing Address - Country:US
Mailing Address - Phone:620-431-9509
Mailing Address - Fax:620-431-0471
Practice Address - Street 1:1202 S PLUMMER AVE
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720-2512
Practice Address - Country:US
Practice Address - Phone:620-431-9509
Practice Address - Fax:620-431-0471
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LIGHTNING CREEK INVESTMENT GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-14
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN-067-009310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100111230CMedicaid