Provider Demographics
NPI:1841393782
Name:CARMEL HILLS HEALTHCARE AND REHABILITATION CENTER, LLC
Entity Type:Organization
Organization Name:CARMEL HILLS HEALTHCARE AND REHABILITATION CENTER, LLC
Other - Org Name:CARMEL HILLS HEALTHCARE AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-468-4752
Mailing Address - Street 1:810 EAST WALNUT
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64050
Mailing Address - Country:US
Mailing Address - Phone:816-461-9600
Mailing Address - Fax:816-461-9650
Practice Address - Street 1:810 EAST WALNUT
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64050
Practice Address - Country:US
Practice Address - Phone:816-461-9600
Practice Address - Fax:816-461-9650
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-06
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO043800314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO105422703Medicaid
MO265727Medicare Oscar/Certification