Derby Assisted Living, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

N087066 Issued in KS

Legal business name

DERBY ASSISTED LIVING, LLC

Doing business as

Avita Senior Living at Derby

Practice address

719 N. Klein Circle
Derby, KS 67037

Phone

(316) 260-4447

NPI assigned

Sep 5, 2012

Last updated

Sep 5, 2012By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Fred Hermes

Title

Managing Member

Phone

(316) 773-1313

Specialties & licenses 1

Addresses

Other names 1

• Avita Senior Living at Derby Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

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

{
    "created_epoch": "1346803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1346803200000",
    "number": "1396094470",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7200 W 13TH",
            "address_2": "SUITE 10",
            "city": "WICHITA",
            "state": "KS",
            "postal_code": "67212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "719 N. KLEIN CIRCLE",
            "city": "DERBY",
            "state": "KS",
            "postal_code": "67037",
            "telephone_number": "316-260-4447"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DERBY ASSISTED LIVING, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-09-05",
        "last_updated": "2012-09-05",
        "status": "A",
        "authorized_official_last_name": "HERMES",
        "authorized_official_first_name": "FRED",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "316-773-1313"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "KS",
            "license": "N087066",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Avita Senior Living at Derby",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Courtney Rae Dejong, DPT
• Gillian Darlene Delano, LMSW
• Dennis C. McAllister, DDS, PA (Tanglewood Family Dentistry)
• Dental Professionals LLC
• Kelsey Elizabeth Depew
• Derby Derm
• Derby Emotional Wellness
• Derby Eyecare LLC
• Derby Health & Rehabilitation
• Derby Modern Dentistry, PA (Derby Modern Dentistry)

• Assisted Living Facility in Derby, KS
• Providers in Derby, KS by specialty
• Assisted Living Facility in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.