Provider Demographics
NPI:1700437258
Name:MIDWESTERN MEDICAL CONSULTANTS LLC
Entity Type:Organization
Organization Name:MIDWESTERN MEDICAL CONSULTANTS LLC
Other - Org Name:DBA MOCKINGBIRD MANOR RESIDENTIAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:KATHENNE
Authorized Official - Last Name:LOMBARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-781-8058
Mailing Address - Street 1:P.O. BOX 101
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64069
Mailing Address - Country:US
Mailing Address - Phone:816-781-8058
Mailing Address - Fax:816-781-6336
Practice Address - Street 1:227 W. FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068
Practice Address - Country:US
Practice Address - Phone:816-781-8058
Practice Address - Fax:816-781-8058
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness