Organization
HIDDEN LAKE SNF OPCO, LLC
Active
Other names
Hidden Lake Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
MARY BETH HUNDLEY (CHIEF ACCOUNTING OFFICER)
(863) 259-9800
Entity
Organization
Contact information
Practice address
11400 HIDDEN LAKE DR, RAYTOWN, MO 64133-7409
(816) 737-1010
Mailing address
20 3RD ST SW STE 308, WINTER HAVEN, FL 33880-2969
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103256202
—
MO
Enumeration date
06/26/2020
Last updated
07/21/2020
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