Provider Demographics
NPI:1720214620
Name:SENIOR CARE OF KANSAS LLC
Entity Type:Organization
Organization Name:SENIOR CARE OF KANSAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:FARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:720-887-4955
Mailing Address - Street 1:3690 W 112TH AVE UNIT 205
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80031-2118
Mailing Address - Country:US
Mailing Address - Phone:720-887-4955
Mailing Address - Fax:720-887-4955
Practice Address - Street 1:3690 W 112TH AVE UNIT 205
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CO
Practice Address - Zip Code:80031-2118
Practice Address - Country:US
Practice Address - Phone:720-887-4955
Practice Address - Fax:720-887-4955
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-05
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO115260363LF0000X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Single Specialty