# DERBY ASSISTED LIVING, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Avita Senior Living at Derby
- **Organization subpart:** No

## Provider details

- **NPI number:** 1396094470
- **Authorized official:** FRED HERMES (MANAGING MEMBER)
- **Authorized official phone:** (316) 773-1313

## Contact information

- **Practice address:** 719 N. KLEIN CIRCLE, DERBY, KS 67037
- **Practice address phone:** (316) 260-4447
- **Mailing address:** 7200 W 13TH, SUITE 10, WICHITA, KS 67212

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | N087066 | KS | Yes |

## Other

- **Enumeration date:** 09/05/2012
- **Last updated:** 09/05/2012