Provider Demographics
NPI:1366476483
Name:JEFFERSON COUNTY MEMORIAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:JEFFERSON COUNTY MEMORIAL HOSPITAL, INC.
Other - Org Name:JEFFERSON COUNTY MEMORIAL HOSPITAL ASSISTED LIVING FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAMONT
Authorized Official - Middle Name:M
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-774-4340
Mailing Address - Street 1:408 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KS
Mailing Address - Zip Code:66097-4003
Mailing Address - Country:US
Mailing Address - Phone:913-774-4340
Mailing Address - Fax:913-774-3329
Practice Address - Street 1:408 DELAWARE ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KS
Practice Address - Zip Code:66097-4003
Practice Address - Country:US
Practice Address - Phone:913-774-4340
Practice Address - Fax:913-774-3329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSHO44001310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility