Provider Demographics
NPI:1013130194
Name:KING LONG TERM CARE FACILITY
Entity Type:Organization
Organization Name:KING LONG TERM CARE FACILITY
Other - Org Name:CARRIE DUMAS LONG TERM CARE FACILITY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-924-5017
Mailing Address - Street 1:2836 BENTON BLVD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64128-1140
Mailing Address - Country:US
Mailing Address - Phone:816-924-5017
Mailing Address - Fax:
Practice Address - Street 1:2836 BENTON BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64128-1140
Practice Address - Country:US
Practice Address - Phone:816-924-5017
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031840310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility