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General NPI Number Information
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NPI Number | 1770587040
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Entity Type | Organization
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Legal Business Name | JOHN KNOX VILLAGE
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Dates
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Enumeration Date | 06/02/2005
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Last Update Date | 12/26/2024
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Provider Practice Location Address
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Address Line | 600 NW PRYOR RD UNIT 300
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City | LEES SUMMIT
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State | MO
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Zip | 64081-1104
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Country | US
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Telephone | 816-524-1133
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Fax | 816-347-1979
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Provider Business Mailing Address
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Address Line | 400 NW MURRAY ROAD
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City | LEES SUMMIT
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State | MO
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Zip | 64081-1499
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Country | US
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Telephone | 816-347-2030
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Fax | 816-347-1979
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Authorized Official
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Title or Position | VICE PRESIDENT HEALTH SERVICES
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Name | ANTHONY COLUMBATTO
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Credential |
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Telephone | 816-347-2030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 132-20
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License Number State | MO
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