Basic Information
Provider Information | |||||||||
NPI: | 1487869772 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | INTEGRATED HEALTH SERVICES OF CLIFF MANOR, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | INTEGRATED HEALTH SERVICES OF KANSAS CITY AT ALPINE NORTH | ||||||||
OtherOrganizationType: | 5 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1680 MICHIGAN AVE | ||||||||
Address2: | SUITE 736 | ||||||||
City: | MIAMI BEACH | ||||||||
State: | FL | ||||||||
PostalCode: | 331392538 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3058921790 | ||||||||
FaxNumber: | 3055382699 | ||||||||
Practice Location | |||||||||
Address1: | 4700 NW CLIFF VIEW DR | ||||||||
Address2: |   | ||||||||
City: | KANSAS CITY | ||||||||
State: | MO | ||||||||
PostalCode: | 641501237 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3058921790 | ||||||||
FaxNumber: | 3055382699 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/11/2007 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | DUAY | ||||||||
AuthorizedOfficialFirstName: | THEODORE | ||||||||
AuthorizedOfficialMiddleName: | M. | ||||||||
AuthorizedOfficialTitleorPosition: | CFO | ||||||||
AuthorizedOfficialTelephone: | 3058921790 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: | III | ||||||||
AuthorizedOfficialCredential: | CPA | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 313M00000X | 032572 | MO | Y |   | Nursing & Custodial Care Facilities | Nursing Facility/Intermediate Care Facility |   |
No ID Information.