Organization
LAKEWOOD SENIOR LIVING OF SEVILLE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TOM KENT (EXECUTIVE VICE PRESIDENT)
(205) 320-7554
Entity
Organization
Contact information
Practice address
1319 SEVILLE ST, WICHITA, KS 67209-1828
(316) 722-5641
Mailing address
3008 7TH AVE S, BIRMINGHAM, AL 35233-3503
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
N087010
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100001100125
—
KS
Enumeration date
11/24/2006
Last updated
08/22/2020
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