Healthcare Provider Details

I. General information

NPI: 1306846100
Provider Name (Legal Business Name): PLAZA MANOR, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2005
Last Update Date: 01/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4330 WASHINGTON ST
KANSAS CITY MO
64111-3340
US

IV. Provider business mailing address

4330 WASHINGTON ST
KANSAS CITY MO
64111-3340
US

V. Phone/Fax

Practice location:
  • Phone: 816-753-6800
  • Fax: 816-931-5528
Mailing address:
  • Phone: 816-753-6800
  • Fax: 816-931-5528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number027102
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number027102
License Number StateMO

VIII. Authorized Official

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