Provider Demographics
NPI:1053733485
Name:KANSAS CITY TRANSITIONAL CARE CENTER, LLC
Entity type:Organization
Organization Name:KANSAS CITY TRANSITIONAL CARE CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-468-4752
Mailing Address - Street 1:3910 RAINBOW BLVD.
Mailing Address - Street 2:SUITE 400
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66103-2918
Mailing Address - Country:US
Mailing Address - Phone:913-901-8462
Mailing Address - Fax:
Practice Address - Street 1:3910 RAINBOW BLVD.
Practice Address - Street 2:SUITE 400
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66103-2918
Practice Address - Country:US
Practice Address - Phone:913-901-8462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-21
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSN105017314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
175544Medicare Oscar/Certification