Provider Demographics
NPI:1821121591
Name:KABUL NURSING HOMES INC
Entity Type:Organization
Organization Name:KABUL NURSING HOMES INC
Other - Org Name:LANDMARK VILLA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT, BOARD OF DIRECTORS
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:COATS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-962-3713
Mailing Address - Street 1:1101 OZARK AVE
Mailing Address - Street 2:
Mailing Address - City:CABOOL
Mailing Address - State:MO
Mailing Address - Zip Code:65689-9358
Mailing Address - Country:US
Mailing Address - Phone:417-962-3713
Mailing Address - Fax:417-962-4947
Practice Address - Street 1:1101 OZARK AVE
Practice Address - Street 2:
Practice Address - City:CABOOL
Practice Address - State:MO
Practice Address - Zip Code:65689-9358
Practice Address - Country:US
Practice Address - Phone:417-962-3713
Practice Address - Fax:417-962-4947
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:KABUL NURSING HOMES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-13
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO033625310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO286078001Medicaid