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Organization
LEISURE HOMESTEAD ASSOCIATION
Active
Organization
LEISURE HOMESTEAD ASSOCIATION
Active
Other names
LEISURE HOMESTEAD AT ST JOHN
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES SCOTT YOUNIE (ADMINISTRATOR)
(620) 549-3541
Entity
Organization
Contact information
Practice address
402 N SANTA FE ST, SAINT JOHN, KS 67576-1800
(620) 549-3541
(620) 549-3590
Mailing address
402 N SANTA FE ST, SAINT JOHN, KS 67576-1800
(620) 549-3541
(620) 549-3590
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
N098001
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100110450A
—
KS
01
—
161495
AAHSA ID NO
—
01
—
17E607
FEDERAL PROVIDER NO
—
Enumeration date
02/14/2007
Last updated
01/20/2022
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