Provider Demographics
NPI:1346337516
Name:JOHN KNOX VILLAGE
Entity Type:Organization
Organization Name:JOHN KNOX VILLAGE
Other - Org Name:VILLAGE HOSPICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP HEALTH SERVICES
Authorized Official - Prefix:
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:64081-1426
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 NW CHIPMAN RD
Practice Address - Street 2:SUITE 239
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64081-3912
Practice Address - Country:US
Practice Address - Phone:816-525-0986
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO115-4HO251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO821070802Medicaid
MO821070802Medicaid