Provider Demographics
NPI:1407252661
Name:BICKFORD OF MIDDLETOWN, LLC
Entity type:Organization
Organization Name:BICKFORD OF MIDDLETOWN, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE VP
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FAIRBANKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-782-3200
Mailing Address - Street 1:13795 S MUR LEN RD
Mailing Address - Street 2:SUITE #301
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1675
Mailing Address - Country:US
Mailing Address - Phone:913-782-3200
Mailing Address - Fax:913-782-4851
Practice Address - Street 1:4375 UNION RD
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:OH
Practice Address - Zip Code:45005-5241
Practice Address - Country:US
Practice Address - Phone:937-550-4911
Practice Address - Fax:937-550-4920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-14
Last Update Date:2014-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2534R310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility