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Contact Information

MISSION LAKE CONVALESCENT CENTER INC.
12110 HOLMES RD
KANSAS CITY, MO64145-1707
 Phone: 816-941-3006
 Fax: 816-942-8049
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Skilled Nursing Facility

314000000X A1[8] Skilled Nursing Facility
 

Nursing Facility Supplies

332BN1400X 87 All Other Suppliers
 

Parenteral & Enteral Nutrition

332BP3500X 87 All Other Suppliers
Indicates primary specialty

NPI Profile & details for MISSION LAKE CONVALESCENT CENTER INC.

NPI Number 1770528986
LBN Legal business name MISSION LAKE CONVALESCENT CENTER INC.
Authorized official LOREN REA - (PRESIDENT)
Entity Organization
Organization subpart 1 No
Enumeration date 06/19/2006
Last updated 02/19/2013 - About 13 years ago
Identifiers
MO License # 032111
MO License # 034738
MO Medicaid 102084506
MO Other 1770528986 NPI
MO Other 032111 PROVIDER
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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