MEDICARE: KING LONG TERM CARE FACILITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	310400000X	Assisted Living Facility	031840	MO

General Provider Information

NPI Number	:	1013130194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KING LONG TERM CARE FACILITY

Provider Business Mailing Address
First Line	:	2836 BENTON BLVD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64128-1140
Country	:	US
Telephone Number	:	816-924-5017
Fax Number	:

Provider Business Practice Location Address
First Line	:	2836 BENTON BLVD
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64128-1140
Country	:	US
Telephone Number	:	816-924-5017
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. CARRIE KING
Credential	:
Telephone Number	:	816-924-5017

Provider Enumeration Date	:	04/10/2007
Last Update Date	:	08/22/2020

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