Provider Demographics
NPI:1356339279
Name:KENDALLWOOD HOSPICE COMPANY
Entity type:Organization
Organization Name:KENDALLWOOD HOSPICE COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:Y
Authorized Official - Last Name:REICHERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-587-1000
Mailing Address - Street 1:2908 NW VIVION RD
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:MO
Mailing Address - Zip Code:64150-1502
Mailing Address - Country:US
Mailing Address - Phone:816-587-1000
Mailing Address - Fax:816-587-3000
Practice Address - Street 1:2908 NW VIVION RD
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:MO
Practice Address - Zip Code:64150-1502
Practice Address - Country:US
Practice Address - Phone:816-587-1000
Practice Address - Fax:816-587-3000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2010-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0418HO251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100226560AMedicaid
MO822927505Medicaid
261521Medicare ID - Type Unspecified