Provider Demographics
NPI:1366883662
Name:ERICKSON LIVING HEALTH SERVICES, LLC
Entity type:Organization
Organization Name:ERICKSON LIVING HEALTH SERVICES, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GARBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-402-2323
Mailing Address - Street 1:13800 METCALF AVE
Mailing Address - Street 2:ATTN: EXECUTIVE DIRECTOR
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66223-1200
Mailing Address - Country:US
Mailing Address - Phone:913-897-2700
Mailing Address - Fax:
Practice Address - Street 1:13800 METCALF AVE
Practice Address - Street 2:ATTN: EXECUTIVE DIRECTOR
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66223-1200
Practice Address - Country:US
Practice Address - Phone:913-897-2700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-15
Last Update Date:2015-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS176575Medicare Oscar/Certification