Healthcare Provider Details

I. General information

NPI: 1124205901
Provider Name (Legal Business Name): HMG PARK MANOR OF BELLEVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2008
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 WESLEYAN DR
BELLEVILLE KS
66935-2440
US

IV. Provider business mailing address

1780 HUGHES LANDING BLVD STE 500
THE WOODLANDS TX
77380-4009
US

V. Phone/Fax

Practice location:
  • Phone: 785-527-5636
  • Fax: 785-527-5419
Mailing address:
  • Phone: 281-419-5520
  • Fax: 281-419-5527

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberN079001
License Number StateKS

VIII. Authorized Official

Name: MR. LAURENCE C. DASPIT
Title or Position: CEO
Credential:
Phone: 281-419-5520