Provider Demographics
NPI:1780950089
Name:ADRIEL SKILLED RESIDENTIAL & DAY LLC
Entity type:Organization
Organization Name:ADRIEL SKILLED RESIDENTIAL & DAY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:NICHOLS
Authorized Official - Suffix:
Authorized Official - Credentials:LICENSE PRACTICAL NU
Authorized Official - Phone:913-522-5791
Mailing Address - Street 1:501 E 125TH TER
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-2725
Mailing Address - Country:US
Mailing Address - Phone:913-768-7414
Mailing Address - Fax:913-254-0550
Practice Address - Street 1:12225 S BLACKBOB RD APT 111P
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-6913
Practice Address - Country:US
Practice Address - Phone:913-732-2055
Practice Address - Fax:913-254-0550
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-30
Last Update Date:2012-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSK.S.A. 75-3307B251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care