Oxford Derby Memory Care, LLC

Primary specialty

Alzheimer Center (Dementia Center)Taxonomy code 311500000X

License

N087073 Issued in KS

Legal business name

OXFORD DERBY MEMORY CARE, LLC

Doing business as

Glen Carr House

Practice address

1433 N Hamilton Dr
Derby, KS 67037-8919

Phone

(316) 788-9999

NPI assigned

Jan 10, 2013

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jason Wiley

Title

Manager

Phone

(316) 201-3210

Specialties & licenses 2

Addresses

Other names 1

• Glen Carr House Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1357776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1357776000000",
    "number": "1346587326",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "125 N MARKET ST",
            "address_2": "SUITE 1416",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "672021721",
            "telephone_number": "316-201-3210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1433 N HAMILTON DR",
            "city": "DERBY",
            "state": "KS",
            "postal_code": "670378919",
            "telephone_number": "316-788-9999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OXFORD DERBY MEMORY CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-01-10",
        "last_updated": "2013-01-10",
        "status": "A",
        "authorized_official_last_name": "WILEY",
        "authorized_official_first_name": "JASON",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "316-201-3210"
    },
    "taxonomies": [
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "KS",
            "license": "N087073",
            "primary": true
        },
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "KS",
            "license": "N087078",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Glen Carr House",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Haley Nuss, DPT
• Emily O'Dell, D.O.
• Jordan N Olivarez, DPT
• Julie Olmstead, OTR
• Oluae LLC
• Camilo H Palacio, MD
• Doyle E Palmer III, OT
• Constantine Paul Panakos, DO
• Brandi Pappan
• Andrea Parker, RPH

• Alzheimer Center (Dementia Center) in Derby, KS
• Providers in Derby, KS by specialty
• Alzheimer Center (Dementia Center) in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 10, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.