Provider Demographics
NPI:1760679625
Name:INDEPENDENCE OPERATIONS LLC
Entity Type:Organization
Organization Name:INDEPENDENCE OPERATIONS LLC
Other - Org Name:THE VILLAGES OF JACKSON CREEK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-899-4401
Mailing Address - Street 1:1500 WATERS RIDGE DR
Mailing Address - Street 2:STE 200
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75057-6011
Mailing Address - Country:US
Mailing Address - Phone:972-899-4401
Mailing Address - Fax:972-899-4806
Practice Address - Street 1:3980 S. JACKSON DR.
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64057-1706
Practice Address - Country:US
Practice Address - Phone:816-795-1433
Practice Address - Fax:816-795-1766
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STONEGATE SENIOR CARE, LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-25
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO035304310400000X
MO035303314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101488302Medicaid
MO101488302Medicaid