Provider Demographics
NPI:1427045467
Name:CROWN CARE CENTER OF HARRISONVILLE, L.C.
Entity Type:Organization
Organization Name:CROWN CARE CENTER OF HARRISONVILLE, L.C.
Other - Org Name:CROWN CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-380-6525
Mailing Address - Street 1:3001 E ELM ST
Mailing Address - Street 2:
Mailing Address - City:HARRISONVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:64701-1196
Mailing Address - Country:US
Mailing Address - Phone:816-380-6525
Mailing Address - Fax:816-380-4963
Practice Address - Street 1:3001 E ELM ST
Practice Address - Street 2:
Practice Address - City:HARRISONVILLE
Practice Address - State:MO
Practice Address - Zip Code:64701-1196
Practice Address - Country:US
Practice Address - Phone:816-380-6525
Practice Address - Fax:816-380-4963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-04
Last Update Date:2014-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO027621314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO108252602Medicaid
MO108252602Medicaid