Organization
ANDOVER SENIOR CARE, LLC
Active
Other names
Victoria Falls
Organization subpart
No
Provider details
NPI number
Authorized official
DENNIS BUSH (CEO)
(316) 733-2645
Entity
Organization
Contact information
Practice address
224 E CENTRAL AVE, ANDOVER, KS 67002
(316) 733-0654
Mailing address
PO BOX 906, ANDOVER, KS 67002-0906
(316) 733-0654
(316) 733-0995
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
175520
PTAN
KS
05
—
200363120A
—
KS
01
—
N008012
KANSAS DEPARTMENT ON AGING
KS
Enumeration date
05/13/2010
Last updated
12/07/2015
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