1528702669 NPI number — KC CONCIERGE SERVICES, LLC

Table of content: (NPI 1528702669)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528702669 NPI number — KC CONCIERGE SERVICES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KC CONCIERGE SERVICES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528702669
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8820 MONROVIA ST # 19494
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LENEXA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66215-3539
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-485-6136
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7611 W 156TH TER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OVERLAND PARK
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66223-1719
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-617-4548
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/25/2022

Additional Information

Authorized Official

Authorized Official Last Name:
DORBOR
Authorized Official First Name:
FLORENCE
Authorized Official Middle Name:
GAYNOH
Authorized Official Title or Position:
ASSISTANT ADMINISTRATOR
Authorized Official Telephone Number:
913-617-4548

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 23-37681-092 . This is a "LPN" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".




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