Provider Demographics
NPI:1700234937
Name:N & R OF SOUTH KANSAS CITY LLC
Entity Type:Organization
Organization Name:N & R OF SOUTH KANSAS CITY LLC
Other - Org Name:TIMBERLAKE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MATHIAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:DASAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-481-9625
Mailing Address - Street 1:12110 HOLMES RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64145-1707
Mailing Address - Country:US
Mailing Address - Phone:816-941-3006
Mailing Address - Fax:
Practice Address - Street 1:12110 HOLMES RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64145-1707
Practice Address - Country:US
Practice Address - Phone:816-941-3006
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-27
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO102084506Medicaid
MO265637Medicare Oscar/Certification