Provider Demographics
NPI:1740840180
Name:RESIDENCE BEGONIA II AT CRESTVIEW LLC
Entity type:Organization
Organization Name:RESIDENCE BEGONIA II AT CRESTVIEW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BEATRICE
Authorized Official - Middle Name:TANG
Authorized Official - Last Name:DISASI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-616-5306
Mailing Address - Street 1:8714 E HARRY CT
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-4616
Mailing Address - Country:US
Mailing Address - Phone:316-616-5306
Mailing Address - Fax:316-201-6136
Practice Address - Street 1:15 CRESTVIEW LAKES EST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-2913
Practice Address - Country:US
Practice Address - Phone:316-616-5306
Practice Address - Fax:316-201-6136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-18
Last Update Date:2019-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
B087209OtherKDADS