# CCRC OF OVERLAND PARK, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Colonial Village
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063946143
- **Authorized official:** GILBERT R WOOD (MANAGER OF THE LLC)
- **Authorized official phone:** (913) 599-5705

## Contact information

- **Practice address:** 12500 W 137TH ST, OVERLAND PARK, KS 66221-4129
- **Practice address phone:** (913) 730-3700
- **Mailing address:** 12500 W. 137TH STREET, OVERLAND PARK, KS 66221
- **Mailing address phone:** (913) 730-3700

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 314000000X | Skilled Nursing Facility | — | — | Yes |

## Other

- **Enumeration date:** 04/17/2017
- **Last updated:** 02/20/2019