Provider Demographics
NPI:1912258823
Name:SENIORS ON THE GREEN ADULT CARE CENTER LLC
Entity Type:Organization
Organization Name:SENIORS ON THE GREEN ADULT CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:L
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:913-271-4727
Mailing Address - Street 1:19795 W 183RD ST
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-9271
Mailing Address - Country:US
Mailing Address - Phone:913-271-4727
Mailing Address - Fax:913-592-2988
Practice Address - Street 1:19795 W 183RD ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-9271
Practice Address - Country:US
Practice Address - Phone:913-271-4727
Practice Address - Fax:913-592-2988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSB046047385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care