Provider Demographics
NPI:1336353077
Name:CARROLL MANOR
Entity Type:Organization
Organization Name:CARROLL MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:JR
Authorized Official - Credentials:RN
Authorized Official - Phone:816-365-5433
Mailing Address - Street 1:3400 CAMPBELL ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64109-2354
Mailing Address - Country:US
Mailing Address - Phone:816-531-5746
Mailing Address - Fax:816-531-5398
Practice Address - Street 1:3400 CAMPBELL ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64109-2354
Practice Address - Country:US
Practice Address - Phone:816-531-5746
Practice Address - Fax:816-531-5398
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO033243313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility