# LEISURE HOMESTEAD ASSOCIATION

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Leisure Homestead at Stafford
- **Organization subpart:** No

## Provider details

- **NPI number:** 1447393160
- **Authorized official:** SCOTT YOUNIE (ADMINISTRATOR)
- **Authorized official phone:** (620) 234-5208

## Contact information

- **Practice address:** 405 GRAND AVE, STAFFORD, KS 67578-2009
- **Practice address phone:** (620) 234-5208
- **Practice address fax:** (620) 234-6911
- **Mailing address:** 405 GRAND AVE, STAFFORD, KS 67578-2009
- **Mailing address phone:** (620) 234-5208
- **Mailing address fax:** (620) 234-6911

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | N093002 | KS | Yes |

## Other

- **Enumeration date:** 02/14/2007
- **Last updated:** 01/20/2022

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 100109230A | — | KS |
| 01 | — | 130494 | AAHSA ID | KS |
| 01 | — | 17E581 | FEDERAL PROVIDER NO | — |
| 01 | — | N093002 | STATE REGISTRY | KS |