Provider Demographics
NPI:1972645125
Name:GUEST HOME ESTATES OF FT SCOTT,LLC
Entity type:Organization
Organization Name:GUEST HOME ESTATES OF FT SCOTT,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:LAIDLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-249-3457
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:FORT SCOTT
Mailing Address - State:KS
Mailing Address - Zip Code:66701-0936
Mailing Address - Country:US
Mailing Address - Phone:620-249-3457
Mailing Address - Fax:620-223-0942
Practice Address - Street 1:737 HEYLMAN ST
Practice Address - Street 2:
Practice Address - City:FORT SCOTT
Practice Address - State:KS
Practice Address - Zip Code:66701-2421
Practice Address - Country:US
Practice Address - Phone:620-249-3457
Practice Address - Fax:620-223-0942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2024-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS30003942130001Medicaid