Provider Demographics
NPI:1255033759
Name:JOHN KNOX VILLAGE
Entity type:Organization
Organization Name:JOHN KNOX VILLAGE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT, HEALTH SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:COLUMBATTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-347-2030
Mailing Address - Street 1:400 NW MURRAY RD
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64081-1498
Mailing Address - Country:US
Mailing Address - Phone:816-347-2109
Mailing Address - Fax:
Practice Address - Street 1:5350 W 94TH TER STE 205
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66207-2520
Practice Address - Country:US
Practice Address - Phone:913-403-8343
Practice Address - Fax:913-262-5854
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHN KNOX VILLAGE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-20
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based