Provider Demographics
NPI:1255323283
Name:COLUMBIA HEALTH FACILITIES-CAMBRIDGE,LLC
Entity Type:Organization
Organization Name:COLUMBIA HEALTH FACILITIES-CAMBRIDGE,LLC
Other - Org Name:STRATFORD COMMONS MEMORY CARE COMMUNITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:C
Authorized Official - Last Name:TUTERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-444-0900
Mailing Address - Street 1:12340 QUIVIRA RD
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66213-2408
Mailing Address - Country:US
Mailing Address - Phone:913-851-0215
Mailing Address - Fax:913-851-8675
Practice Address - Street 1:12340 QUIVIRA RD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66213-2408
Practice Address - Country:US
Practice Address - Phone:913-851-0215
Practice Address - Fax:913-851-8675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2013-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN-046-045310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200331600AMedicaid