Provider Demographics
NPI:1962562785
Name:LEXINGTON PARK NURSING OPERATIONS, LLC
Entity type:Organization
Organization Name:LEXINGTON PARK NURSING OPERATIONS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICAHAEL
Authorized Official - Middle Name:D
Authorized Official - Last Name:TRYON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:785-272-1535
Mailing Address - Street 1:1031 SW FLEMING CT
Mailing Address - Street 2:
Mailing Address - City:TOPEKA
Mailing Address - State:KS
Mailing Address - Zip Code:66604-1851
Mailing Address - Country:US
Mailing Address - Phone:785-440-0500
Mailing Address - Fax:785-440-0505
Practice Address - Street 1:1031 SW FLEMING CT
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66604
Practice Address - Country:US
Practice Address - Phone:785-440-0500
Practice Address - Fax:785-440-0505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2018-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS175154314000000X
KS313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Not Answered313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100112050AMedicaid
KS175154Medicare Oscar/Certification