Healthcare Provider Details

I. General information

NPI: 1023005592
Provider Name (Legal Business Name): JOHN KNOX VILLAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 NW PRYOR RD
LEES SUMMIT MO
64081-1104
US

IV. Provider business mailing address

400 NW MURRAY RD
LEES SUMMIT MO
64081-1499
US

V. Phone/Fax

Practice location:
  • Phone: 816-347-2400
  • Fax:
Mailing address:
  • Phone: 816-347-2400
  • Fax: 816-525-3473

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number031448
License Number StateMO

VIII. Authorized Official

Name: MR. ANTHONY COLUMBATTO
Title or Position: VP - HEALTH & RESIDENT SERVICES
Credential:
Phone: 816-347-2030