Hillside Village, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

N046064 Issued in KS

Legal business name

HILLSIDE VILLAGE, LLC

Practice address

33600 W 85TH
Desoto, KS 66018

Phone

(913) 558-3126

Fax

(913) 585-1225

NPI assigned

Sep 26, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Michael Frank Egan

Title

Ceo

Phone

(913) 583-1260

Specialties & licenses 2

Addresses

Other identifiers 3

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1328745600000",
    "number": "1801997101",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33600 W 85TH",
            "city": "DESOTO",
            "state": "KS",
            "postal_code": "66018",
            "telephone_number": "913-558-3126",
            "fax_number": "913-585-1225"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33600 W 85TH",
            "city": "DESOTO",
            "state": "KS",
            "postal_code": "66018",
            "telephone_number": "913-558-3126",
            "fax_number": "913-585-1225"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HILLSIDE VILLAGE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2012-02-09",
        "status": "A",
        "authorized_official_last_name": "EGAN",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "FRANK",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "913-583-1260",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "KS",
            "license": "N046064",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "KS",
            "license": "N046064",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1042049201",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100644420B",
            "state": "KS"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100644420A",
            "state": "KS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Charles H Klestinske, DDS

• All providers in Desoto, KS
• Skilled Nursing Facility in Kansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 9, 2012; 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.