Provider Demographics
NPI:1669856720
Name:EMERALD SENIOR LIVING
Entity Type:Organization
Organization Name:EMERALD SENIOR LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LEANDRO
Authorized Official - Middle Name:
Authorized Official - Last Name:SANLATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-618-4882
Mailing Address - Street 1:1226 S BYRON RD
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67209-1812
Mailing Address - Country:US
Mailing Address - Phone:316-618-4882
Mailing Address - Fax:316-869-1200
Practice Address - Street 1:1226 S BYRON RD
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67209-1812
Practice Address - Country:US
Practice Address - Phone:316-618-4882
Practice Address - Fax:316-869-1200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-17
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service