Provider Demographics
NPI:1023005592
Name:JOHN KNOX VILLAGE
Entity Type:Organization
Organization Name:JOHN KNOX VILLAGE
Other - Org Name:JOHN KNOX VILLAGE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP - HEALTH & RESIDENT SERVICES
Authorized Official - Prefix:MR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCBRIDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-347-2030
Mailing Address - Street 1:400 NW MURRAY RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-1499
Mailing Address - Country:US
Mailing Address - Phone:816-347-2400
Mailing Address - Fax:816-525-3473
Practice Address - Street 1:600 NW PRYOR RD
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-1104
Practice Address - Country:US
Practice Address - Phone:816-347-2400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-30
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031448314000000X
341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101488401Medicaid
MO801488404Medicaid
MO801488404Medicaid
265095Medicare Oscar/Certification