Provider Demographics
NPI:1730813908
Name:ELDER LIVING LLC
Entity type:Organization
Organization Name:ELDER LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAMLA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-617-4607
Mailing Address - Street 1:155 NW 10 AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-9352
Mailing Address - Country:US
Mailing Address - Phone:620-282-3733
Mailing Address - Fax:
Practice Address - Street 1:155 NW 10 AVE
Practice Address - Street 2:
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-9352
Practice Address - Country:US
Practice Address - Phone:620-617-4281
Practice Address - Fax:620-800-1004
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-13
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility