Provider Demographics
NPI:1235127630
Name:MYERSNURSINGHOME
Entity Type:Organization
Organization Name:MYERSNURSINGHOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DOREEN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:CRUTCHFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-231-3180
Mailing Address - Street 1:2315 WALROND AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64127-4210
Mailing Address - Country:US
Mailing Address - Phone:816-231-3180
Mailing Address - Fax:816-231-5941
Practice Address - Street 1:2315 WALROND AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64127-4210
Practice Address - Country:US
Practice Address - Phone:816-231-3180
Practice Address - Fax:816-231-5941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031488313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility