Waterford South Assisted Living

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

251E00000X Issued in MO

Legal business name

WATERFORD SOUTH ASSISTED LIVING

Practice address

11515 Holmes Rd
Kansas City, MO 64131-3856

Phone

(816) 942-4898

Fax

(816) 942-3278

NPI assigned

Aug 24, 2007

Organization subpart

No

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

Authorized official

Name

Mr. Alfredo E. Egbadon

Title

Administrator

Phone

(816) 942-4898

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1187913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187913600000",
    "number": "1386837110",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11515 HOLMES RD",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641313856"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11515 HOLMES RD",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641313856",
            "telephone_number": "816-942-4898",
            "fax_number": "816-942-3278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATERFORD SOUTH ASSISTED LIVING",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-24",
        "last_updated": "2007-08-24",
        "status": "A",
        "authorized_official_last_name": "EGBADON",
        "authorized_official_first_name": "ALFREDO",
        "authorized_official_middle_name": "E.",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "816-942-4898",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MO",
            "license": "251E00000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dennis William Watkins, R.PH.

• Assisted Living Facility in Kansas City, MO
• Providers in Kansas City, MO by specialty
• Assisted Living Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2007; 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.