Covenant Place of Lenexa, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

COVENANT PLACE OF LENEXA, INC.

Practice address

8505 Pflumm Rd
Lenexa, KS 66215-2461

Phone

(913) 307-2000

Fax

(913) 322-0200

NPI assigned

Apr 23, 2012

Last updated

Jan 2, 2015By the provider in NPPES

Organization subpart

Yes

Parent organization

COVENANT RETIREMENT SERVICESAs reported in NPPES

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

Authorized official

Name

Scott E Gulledge

Title

Manager

Phone

(913) 890-4782

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1335139200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1420156800000",
    "number": "1689931016",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11827 W 112TH ST",
            "address_2": "SUITE 103",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662102726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8505 PFLUMM RD",
            "city": "LENEXA",
            "state": "KS",
            "postal_code": "662152461",
            "telephone_number": "913-307-2000",
            "fax_number": "913-322-0200"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COVENANT PLACE OF LENEXA, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COVENANT RETIREMENT SERVICES",
        "enumeration_date": "2012-04-23",
        "last_updated": "2015-01-02",
        "status": "A",
        "authorized_official_last_name": "GULLEDGE",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "913-890-4782"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "17E644",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2015; 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.