Provider Demographics
NPI:1740608660
Name:UNITED SENIOR PROPERTIES OF SHAWNEE, LLC
Entity Type:Organization
Organization Name:UNITED SENIOR PROPERTIES OF SHAWNEE, LLC
Other - Org Name:AVONLEA COTTAGE OF SHAWNEE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-492-7800
Mailing Address - Street 1:789 E COUNTRY GROVE DR
Mailing Address - Street 2:
Mailing Address - City:SHAWNEE
Mailing Address - State:OK
Mailing Address - Zip Code:74804-1404
Mailing Address - Country:US
Mailing Address - Phone:405-273-3323
Mailing Address - Fax:
Practice Address - Street 1:789 E COUNTRY GROVE DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74804-1404
Practice Address - Country:US
Practice Address - Phone:405-273-3323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-29
Last Update Date:2014-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKAL6302310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility