# ANDOVER SENIOR CARE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Victoria Falls
- **Organization subpart:** No

## Provider details

- **NPI number:** 1689992752
- **Authorized official:** DENNIS BUSH (CEO)
- **Authorized official phone:** (316) 733-2645

## Contact information

- **Practice address:** 224 E CENTRAL AVE, ANDOVER, KS 67002
- **Practice address phone:** (316) 733-0654
- **Mailing address:** PO BOX 906, ANDOVER, KS 67002-0906
- **Mailing address phone:** (316) 733-0654
- **Mailing address fax:** (316) 733-0995

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | NULL | Yes |

## Other

- **Enumeration date:** 05/13/2010
- **Last updated:** 12/07/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 175520 | PTAN | KS |
| 05 | — | 200363120A | — | KS |
| 01 | — | N008012 | KANSAS DEPARTMENT ON AGING | KS |