Healthcare Provider Details

I. General information

NPI: 1689775264
Provider Name (Legal Business Name): EXCELSIOR SPRINGS CITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 06/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 RAINBOW BLVD
EXCELSIOR SPRINGS MO
64024-1182
US

IV. Provider business mailing address

1700 RAINBOW BLVD
EXCELSIOR SPRINGS MO
64024-1182
US

V. Phone/Fax

Practice location:
  • Phone: 816-630-6081
  • Fax: 816-629-2701
Mailing address:
  • Phone: 816-630-6081
  • Fax: 816-629-2701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number286-28
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier100421601
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer

VIII. Authorized Official

Name: SALLY S NANCE
Title or Position: CEO
Credential:
Phone: 816-630-6081