Provider Demographics
NPI:1306846100
Name:PLAZA MANOR, INC
Entity Type:Organization
Organization Name:PLAZA MANOR, INC
Other - Org Name:THE PLAZA REHABILITATION & HEALTH CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, CEO
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 1:4330 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3340
Mailing Address - Country:US
Mailing Address - Phone:816-753-6800
Mailing Address - Fax:816-931-5528
Practice Address - Street 1:4330 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3340
Practice Address - Country:US
Practice Address - Phone:816-753-6800
Practice Address - Fax:816-931-5528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-22
Last Update Date:2014-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO027102314000000X, 332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101860302Medicaid
MO265199Medicare Oscar/Certification
MO0749710001Medicare NSC