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NPI Code Detail

MEDICARE: HOLMESDALE HEALTHCARE AND REHABILITATION CENTER, LLC

MEDICARE: HOLMESDALE HEALTHCARE AND REHABILITATION CENTER, LLC
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
1314000000XSkilled Nursing Facility043417MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1639195936
Entity Type Code : Organization
Provider Name (Legal Business Name) : HOLMESDALE HEALTHCARE AND REHABILITATION CENTER, LLC
Provider Business Mailing Address
First Line : 8033 HOLMES RD
Second Line :
City : KANSAS CITY
State : MO
Zip : 64131-2115
Country : US
Telephone Number : 816-363-6222
Fax Number : 816-361-2025
Provider Business Practice Location Address
First Line : 8033 HOLMES RD
Second Line :
City : KANSAS CITY
State : MO
Zip : 64131-2115
Country : US
Telephone Number : 816-363-6222
Fax Number : 816-361-2025
Authorized Official
Title or Position : ASSISTANT SECRETARY
Name : MICHAEL T. BERG
Credential :
Telephone Number : 505-468-4752
Provider Enumeration Date : 07/14/2006
Last Update Date : 01/26/2016

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