Healthcare Provider Details

I. General information

NPI: 1699986018
Provider Name (Legal Business Name): LAKEWOOD CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NE MEADOWVIEW DR
LEES SUMMIT MO
64064-1983
US

IV. Provider business mailing address

600 NE MEADOWVIEW DR
LEES SUMMIT MO
64064-1983
US

V. Phone/Fax

Practice location:
  • Phone: 816-554-9866
  • Fax: 816-554-9867
Mailing address:
  • Phone: 816-554-9866
  • Fax: 816-554-9867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number032369
License Number StateMO

VIII. Authorized Official

Name: MR. STEVE BUNCH
Title or Position: VICE PRESIDENT OF OPERATIONS
Credential:
Phone: 816-554-9866