# HOMESTEAD OF DERBY OPERATIONS, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Homestead of Derby
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700321486
- **Authorized official:** MICHAEL D TRYON CPA (CFO)
- **Authorized official phone:** (785) 272-1535

## Contact information

- **Practice address:** 1701 E WALNUT GROVE RD, DERBY, KS 67037-3528
- **Practice address phone:** (316) 788-9600
- **Practice address fax:** (316) 788-8963
- **Mailing address:** 3715 SW 29TH ST STE 200, TOPEKA, KS 66614-2164
- **Mailing address phone:** (785) 272-1535
- **Mailing address fax:** (785) 272-1480

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 310400000X | Assisted Living Facility | N087036 | KS | Yes |

## Other

- **Enumeration date:** 01/04/2017
- **Last updated:** 01/04/2017

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | N087036 | — | KS |