Provider Demographics
NPI:1215684816
Name:THE GRESHAM LLC
Entity type:Organization
Organization Name:THE GRESHAM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:EMILEE
Authorized Official - Middle Name:
Authorized Official - Last Name:GLATCZAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-448-6287
Mailing Address - Street 1:1400 TERRADYNE DR STE 316
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:KS
Mailing Address - Zip Code:67002-9264
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1730 N NORTHWEST PKWY
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67212-1548
Practice Address - Country:US
Practice Address - Phone:316-252-3004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-04
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility