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Organization

INDEPENDENCE MANOR INC

Active
Other names
Independence Manor Care Center
Organization subpart
No

Provider details

NPI number
Authorized official
MR. HAL JUCKETTE (OWNER)
(660) 646-5385
Entity
Organization

Contact information

Practice address
1600 S KINGS HIGHWAY, INDEPENDENCE, MO 64055
(816) 833-4777
(816) 833-3032
Mailing address
1600 S KINGS HIGHWAY, INDEPENDENCE, MO 64055
(816) 833-4777
(816) 833-3032

Taxonomy

Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
002374
MO

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
107808503
MO
Enumeration date
09/13/2006
Last updated
07/05/2012
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