Provider Demographics
NPI:1013018399
Name:KANSAS CITY UNITED METHODIST RETIREMENT HOME, INC.
Entity Type:Organization
Organization Name:KANSAS CITY UNITED METHODIST RETIREMENT HOME, INC.
Other - Org Name:KINGSWOOD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:M
Authorized Official - Last Name:LANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-554-6155
Mailing Address - Street 1:10000 WORNALL RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4359
Mailing Address - Country:US
Mailing Address - Phone:816-942-0994
Mailing Address - Fax:816-942-8131
Practice Address - Street 1:10000 WORNALL RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4359
Practice Address - Country:US
Practice Address - Phone:816-942-0994
Practice Address - Fax:816-942-8131
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2019-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031146310400000X
MO031145314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO107808602Medicaid
MO107808602Medicaid