MEDICARE: CLARA MANOR NURSING HOME

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	031741	MO

General Provider Information

NPI Number	:	1992792386
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CLARA MANOR NURSING HOME

Provider Business Mailing Address
First Line	:	3621 WARWICK BLVD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-1403
Country	:	US
Telephone Number	:	816-756-0904
Fax Number	:

Provider Business Practice Location Address
First Line	:	3621 WARWICK BLVD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64111-1403
Country	:	US
Telephone Number	:	816-756-0904
Fax Number	:

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MRS. MARY A PECINA
Credential	:
Telephone Number	:	816-756-1593

Provider Enumeration Date	:	09/30/2005
Last Update Date	:	08/22/2020

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