Provider Demographics
NPI:1902308919
Name:CENTER AT WATERFRONT LLC
Entity Type:Organization
Organization Name:CENTER AT WATERFRONT LLC
Other - Org Name:THE CENTER AT WATERFRONT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEARER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:303-893-0250
Mailing Address - Street 1:1541 N LINDBERG CIR
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-6400
Mailing Address - Country:US
Mailing Address - Phone:316-358-6400
Mailing Address - Fax:316-358-6490
Practice Address - Street 1:1541 NORTH LINDBERG CIRCLE
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67206
Practice Address - Country:US
Practice Address - Phone:316-358-6400
Practice Address - Fax:316-358-6490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-06
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility