Organization
LEISURE HOMESTEAD ASSOCIATION
Active
Other names
Leisure Homestead at Stafford
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT YOUNIE (ADMINISTRATOR)
(620) 234-5208
Entity
Organization
Contact information
Practice address
405 GRAND AVE, STAFFORD, KS 67578-2009
(620) 234-5208
(620) 234-6911
Mailing address
405 GRAND AVE, STAFFORD, KS 67578-2009
(620) 234-5208
(620) 234-6911
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
N093002
KS
Other
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
Enumeration date
02/14/2007
Last updated
01/20/2022
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