INDEPENDENCE MANOR INC (NPI# 1255436556) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255436556 |
| Entity Type | Organization |
| Organization Name | INDEPENDENCE MANOR INC |
| Other Organization Name | INDEPENDENCE MANOR CARE CENTER |
| Practice Address |
1600 S Kings Highway Independence MO 64055 |
| Practice Telephone | 8168334777 |
| Practice Fax Number | 8168333032 |
| Mailing Telephone | 8168334777 |
| Mailing Fax Number | 8168333032 |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2012-07-05 |
| Authorized Official Name | MR. HAL JUCKETTE (OWNER) |
| Authorized Official Telephone | 6606465385 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 314000000X | Skilled Nursing Facility | 002374 | MO | Nursing & Custodial Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MO | 107808503 | 05 |
| Other Name | Type Code |
|---|---|
| Independence Manor Care Center | Doing Business As Name - Organization |
| Street Address |
1600 S KINGS HIGHWAY |
| City | INDEPENDENCE |
| State | MO |
| Zip Code | 64055 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851916035 | Nicholas Portell | Optometrist | 13900 E Us Hwy, Suite A, Independence, MO 64055 | 2020-06-12 |
| 1295396398 | Alyson Forbes | Behavioral Analyst | 4721 S. Cliff Ave, Suite 103, Independence, MO 64055 | 2019-06-28 |
| 1427526458 | Physicians Wellness Group LLC | Family Medicine | 19045 E Valley View Parkway, Suite G, Independence, MO 64055 | 2018-11-07 |
| 1760967707 | Simone Lila Light | Behavioral Analyst | 4721 S. Cliff Ave Suite 103, Suite 103, Independence, MO 64055 | 2018-09-25 |
| 1841786183 | Ladonna Kaye Stephens | Pharmacist | 4100 Bolger Dr, Independence, MO 64055 | 2018-07-10 |
| 1568954873 | Lincare Inc | Durable Medical Equipment & Medical Supplies | 17501 E 40 Hwy Ste 224, Independence, MO 64055 | 2018-06-01 |
| 1710488002 | Zenith Rehabilitation, LLC | Rehabilitation Practitioner | 14500 E 42nd St S Ste 240, Independence, MO 64055 | 2018-02-22 |
| 1720526924 | Ashley & Gray D.d.s.'s | Clinic/Center | 1520 E 23rd Str, Ste Q, Independence, MO 64055 | 2017-02-08 |
| 1942751045 | Mary C Younger | Counselor | 4710 S Cedar Crest Ct Ste 100, Independence, MO 64055 | 2016-10-24 |
| 1497163950 | Carolyn J Wells | Home Health Aide | 13308 E 43rd Terr S, Independence, MO 64055 | 2014-07-29 |
| Find all providers in zip 64055 | ||||
| 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 |
|---|---|---|---|---|
| 1114451648 | Sunterra Independence Oc, LLC | Skilled Nursing Facility | 19200 E 37th Terrace S, Independence, MO 64057-8324 | 2017-04-11 |
| 1023247806 | 325th Combat Support Hospital | Skilled Nursing Facility | 11101 E Independence Ave, Independence, MO 64054-1511 | 2009-07-14 |
| 1841393782 | Carmel Hills Healthcare and Rehabilitation Center, LLC | Skilled Nursing Facility | 810 East Walnut, Independence, MO 64050 | 2006-09-06 |
| 1750305033 | Grayson Facility Operations, LLC | Skilled Nursing Facility | 400 S. Independence Avenue, Independence, VA 24348-3857 | 2006-07-27 |
| 1932132750 | Independence 1 Inc | Skilled Nursing Facility | 10300 E Truman Rd, Independence, MO 64052-2258 | 2006-07-07 |
| 1457396426 | Sp Grayson, LLC | Skilled Nursing Facility | 400 S Independence Ave, Independence, VA 24348-3857 | 2006-06-16 |
| 1104877695 | Ggnsc Independence II LLC | Skilled Nursing Facility | 17451 Medical Center Pkwy, Independence, MO 64057-1805 | 2006-05-12 |
| 1497703201 | Evergreen Oregon Healthcare Independence, L.L.C. | Skilled Nursing Facility | 1525 Monmouth St, Independence, OR 97351-1007 | 2006-05-04 |
| 1992792923 | Regency Care Center of Independence, L.c. | Skilled Nursing Facility | 1800 S Swope Dr, Independence, MO 64057-1084 | 2005-10-04 |
| 1588666127 | Abcm Corporation | Skilled Nursing Facility | 1610 3rd St Ne, Independence, IA 50644-2228 | 2005-08-12 |
| Find all providers in INDEPENDENCE | ||||
| City | INDEPENDENCE |
| Zip Code | 64055 |
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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.