Healthcare Provider Details

I. General information

NPI: 1770583684
Provider Name (Legal Business Name): MONTEREY PARK NURSING CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 09/19/2024
Certification Date: 09/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 LITTLE BLUE PKWY
INDEPENDENCE MO
64057-8302
US

IV. Provider business mailing address

4600 LITTLE BLUE PKWY
INDEPENDENCE MO
64057-8302
US

V. Phone/Fax

Practice location:
  • Phone: 816-795-7888
  • Fax: 816-268-9981
Mailing address:
  • Phone: 816-795-7888
  • Fax: 816-268-9981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number027551
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number027551
License Number StateMO

VIII. Authorized Official

Name: JOSEPH C TUTERA
Title or Position: PRESIDENT, CEO
Credential:
Phone: 816-444-0900