Provider Demographics
NPI:1306965058
Name:DEER PARK SENIOR GROUP HOME INC.
Entity type:Organization
Organization Name:DEER PARK SENIOR GROUP HOME INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:LINTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-484-0100
Mailing Address - Street 1:6313 HWY K4
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:KS
Mailing Address - Zip Code:66512
Mailing Address - Country:US
Mailing Address - Phone:785-484-0100
Mailing Address - Fax:
Practice Address - Street 1:6313 HWY K4
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:KS
Practice Address - Zip Code:66512
Practice Address - Country:US
Practice Address - Phone:785-484-0100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSB044001311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility