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General NPI Number Information
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NPI Number | 1013130194
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Entity Type | Organization
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Legal Business Name | KING LONG TERM CARE FACILITY
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Dates
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Enumeration Date | 04/10/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2836 BENTON BLVD
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City | KANSAS CITY
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State | MO
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Zip | 64128-1140
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Country | US
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Telephone | 816-924-5017
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Fax |
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Provider Business Mailing Address
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Address Line | 2836 BENTON BLVD
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City | KANSAS CITY
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State | MO
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Zip | 64128-1140
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Country | US
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Telephone | 816-924-5017
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. CARRIE KING
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Credential |
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Telephone | 816-924-5017
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 031840
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License Number State | MO
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