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Organization

VILLAGE SHALOM, INC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. MATTHEW EARL LEWIS (PRESIDENT/CEO)
(913) 266-8400
Entity
Organization

Contact information

Practice address
5500 W 123RD ST, OVERLAND PARK, KS 66209-3193
(913) 317-2600
Mailing address
5500 W 123RD ST, OVERLAND PARK, KS 66209-3193
(913) 317-2600

Taxonomy

Speciality
Code
Description
License number
State
261QA0600X
Adult Day Care Clinic/Center
N046054
KS
310400000X
Assisted Living Facility
N046054
KS
311500000X
Alzheimer Center (Dementia Center)
N046054
KS
314000000X
Skilled Nursing Facility
Primary
N046054
KS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
100112060A
KS
01
90924016
BCBS PROVIDER NUMBER
KS
Enumeration date
03/31/2006
Last updated
01/28/2010
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