Provider Demographics
NPI:1861612376
Name:COUNTRY CLUB ESTATES LP
Entity type:Organization
Organization Name:COUNTRY CLUB ESTATES LP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:ACHEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-294-4531
Mailing Address - Street 1:2 LEWIS DR
Mailing Address - Street 2:
Mailing Address - City:PAOLA
Mailing Address - State:KS
Mailing Address - Zip Code:66071-1126
Mailing Address - Country:US
Mailing Address - Phone:913-294-4531
Mailing Address - Fax:913-294-6969
Practice Address - Street 1:2 LEWIS DR
Practice Address - Street 2:
Practice Address - City:PAOLA
Practice Address - State:KS
Practice Address - Zip Code:66071-1126
Practice Address - Country:US
Practice Address - Phone:913-294-4531
Practice Address - Fax:913-294-6969
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility