Provider Demographics
NPI:1851520464
Name:LIFE CENTERS OF KANSAS LLC
Entity Type:Organization
Organization Name:LIFE CENTERS OF KANSAS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DALTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-634-0783
Mailing Address - Street 1:15504 GLENWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-3183
Mailing Address - Country:US
Mailing Address - Phone:913-634-0783
Mailing Address - Fax:
Practice Address - Street 1:10914 W 143RD TER
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66221-8154
Practice Address - Country:US
Practice Address - Phone:913-634-0783
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-06
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200542890AMedicaid