Provider Demographics
NPI:1033579578
Name:CCRC OF GLADSTONE, LLC
Entity Type:Organization
Organization Name:CCRC OF GLADSTONE, LLC
Other - Org Name:LINDEN WOODS VILLAGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:E
Authorized Official - Last Name:GULLEDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-890-4782
Mailing Address - Street 1:11827 W 112TH ST
Mailing Address - Street 2:STE 103
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2726
Mailing Address - Country:US
Mailing Address - Phone:913-890-4780
Mailing Address - Fax:
Practice Address - Street 1:2901 NE 72ND ST
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64119-7400
Practice Address - Country:US
Practice Address - Phone:816-268-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility