Healthcare Provider Details

I. General information

NPI: 1427045467
Provider Name (Legal Business Name): CROWN CARE CENTER OF HARRISONVILLE, L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2005
Last Update Date: 05/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 E ELM ST
HARRISONVILLE MO
64701-1196
US

IV. Provider business mailing address

3001 E ELM ST
HARRISONVILLE MO
64701-1196
US

V. Phone/Fax

Practice location:
  • Phone: 816-380-6525
  • Fax: 816-380-4963
Mailing address:
  • Phone: 816-380-6525
  • Fax: 816-380-4963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number027621
License Number StateMO

VIII. Authorized Official

Name: MR. STEVE BUNCH
Title or Position: VICE PRESIDENT OF OPERATIONS
Credential:
Phone: 816-380-6525