CCRC OF OVERLAND PARK, LLC (NPI# 1063946143) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1063946143 |
| Entity Type | Organization |
| Organization Name | CCRC OF OVERLAND PARK, LLC |
| Other Organization Name | COLONIAL VILLAGE |
| Practice Address |
12500 W 137th St Overland Park KS 66221-4129 |
| Mailing Address |
12500 W. 137th Street Overland Park KS 66221 |
| Practice Telephone | 9137303700 |
| Mailing Telephone | 9137303700 |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2019-02-20 |
| Authorized Official Name | GILBERT R WOOD (MANAGER OF THE LLC) |
| Authorized Official Telephone | 9135995705 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | Nursing & Custodial Care Facilities |
| Other Name | Type Code |
|---|---|
| Colonial Village | Doing Business As Name - Organization |
| Street Address |
12500 W 137TH ST |
| City | OVERLAND PARK |
| State | KS |
| Zip Code | 66221-4129 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942865787 | Haylie Alexis Baughman | Speech-Language Pathologist | 12500 W 137th St, Overland Park, KS 66221-4183 | 2019-05-07 |
| 1912562679 | Amanda Lynn Cook | Physical Therapist | 12500 W 137th St, Overland Park, KS 66221-4183 | 2019-05-07 |
| 1801369350 | New Horizon Care Pa | Family Medicine | 12500 W 137th St, Overland Park, KS 66221-4129 | 2019-01-08 |
| 1073082350 | Geriatric Primary Care Pa | Family Medicine | 12500 W 137th St, Overland Park, KS 66221-4129 | 2018-11-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1750936290 | Roling Chiropractic and Wellness LLC | Chiropractor | 11818 W 135th St, Overland Park, KS 66221 | 2019-08-01 |
| 1518519339 | Joshua Dale Roling | Chiropractor | 11818 West 135th Street, Overland Park, KS 66221 | 2019-07-11 |
| 1225508898 | Keaghan Michelle Shacklett | Specialist/Technologist | 13747 Cody St., Overland Park, KS 66221 | 2018-11-27 |
| 1215341003 | Creighton Gallagher, Dds LLC | Dentist | 8925 W 135th Street, Overland Park, KS 66221 | 2014-06-19 |
| 1508201963 | Jessica Mary Molstad | Nurse Practitioner | 11400 W. 135th Street, Overland Park, KS 66221 | 2013-04-29 |
| 1659687739 | Willie K Yuen | Physical Therapist | 11504 W 135th St., Performance Rehab. LLC, Overland Park, KS 66221 | 2010-08-26 |
| 1730414970 | Sue A. Klein | Physical Therapist | 11504 W. 135th St., Overland Park, KS 66221 | 2009-10-06 |
| 1538375407 | Michelle Tims | Occupational Therapist | 9101 158th St, Overland Park, KS 66221 | 2007-05-15 |
| 1124249321 | Choice of Health Pa | Chiropractor | 9120 W 135th Street, Suite 205, Overland Park, KS 66221 | 2007-05-02 |
| 1396830980 | Heartland Diabetic Supplies LLC | Non-Pharmacy Dispensing Site | 10703 W. 149th Street, Overland Park, KS 66221 | 2006-10-03 |
| Find all providers in zip 66221 | ||||
| Taxonomy Code | 314000000X |
| Grouping | Nursing & Custodial Care Facilities |
| Classification | Skilled Nursing Facility |
| (1) A skilled nursing facility is a facility or distinct part of an institution whose primary function is to provide medical, continuous nursing, and other health and social services to patients who are not in an acute phase of illness requiring services in a hospital, but who require primary restorative or skilled nursing services on an inpatient basis above the level of intermediate or custodial care in order to reach a degree of body functioning to permit self care in essential daily living. It meets any licensing or certification standards et forth by the jurisdiction where it is located. A skilled nursing facility may be a freestanding facility or part of a hospital that has been certified by Medicare to admit patients requiring subacute care and rehabilitation; (2) Provides non-acute medical and skilled nursing care services, therapy and social services under the supervision of a licensed registered nurse on a 24-hour basis. |
| Notes: Source: (1) "Glossary of terms used in managed care" Developed by the Managed Care Assembly (MCA) of Medical Group Management Association (MGMA), MGM Journal, September/October 1995, p. 64; (2) AHA Guide, 1996 Annual Survey. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972041952 | Ccrc of Cedar Rapids, LLC | Skilled Nursing Facility | 11827 W 112th St, Suite 103, Overland Park, KS 66210 | 2017-02-09 |
| 1700262680 | Maple Hills Healthcare, Inc. | Skilled Nursing Facility | 7600 Antioch Rd, Overland Park, KS 66204 | 2015-08-03 |
| 1316034507 | Thi of Kansas At Indian Meadows, LLC | Skilled Nursing Facility | 6505 W 103rd St, Overland Park, KS 66212-1728 | 2006-10-07 |
| 1407943699 | Thi of Kansas At Indian Creek, LLC | Skilled Nursing Facility | 6515 W 103rd St, Overland Park, KS 66212-1728 | 2006-10-07 |
| 1376576371 | Life Care Centers of America, Inc. | Skilled Nursing Facility | 7541 Switzer St, Overland Park, KS 66214-1170 | 2006-07-10 |
| 1346288313 | Overland Park Nursing & Rehab Center Inc | Skilled Nursing Facility | 6501 W 75th St, Overland Park, KS 66204-3074 | 2006-06-03 |
| 1285629048 | Delmar Gardens of Overland Park Operating, LLC | Skilled Nursing Facility | 12100 W 109th St, Overland Park, KS 66210-1200 | 2005-09-16 |
| 1972595080 | Carondelet Long Term Care Facilities Inc | Skilled Nursing Facility | 11901 Rosewood Dr, Overland Park, KS 66209-3533 | 2005-08-16 |
| 1306400841 | Kpc Promise Skilled Nursing Facility of Overland Park LLC | Skilled Nursing Facility | 6505 W 103rd St, Overland Park, KS 66212-1728 | 2019-04-30 |
| 1104399039 | Overland Park Ks Opco LLC | Skilled Nursing Facility | 6515 W 103rd St, Overland Park, KS 66212-1728 | 2019-01-03 |
| Find all providers in OVERLAND PARK | ||||
| City | OVERLAND PARK |
| Zip Code | 66221 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.