CCRC of Lees Summit, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

CCRC OF LEES SUMMIT, LLC

Doing business as

Raintree Village

Practice address

1501 SW Arborwalk Blvd
Lee's Summit, MO 64082

Phone

(913) 599-5705

Fax

(913) 890-4789

NPI assigned

May 25, 2023

Last updated

Mar 17, 2025By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Gilbert R Wood

Title

Manager of the LLC

Phone

(913) 599-5705

Specialties & licenses 1

Addresses

Other names 1

• Raintree Village Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1205528353. Details of each certification follow.

• CCN 265888 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 265888

Legal name

CCRC OF LEES SUMMIT LLC

Doing business as

RAINTREE VILLAGE

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

May 2, 2025

Last certification

May 2, 2025

Beds

40

Ownership / control type

Corporation

Organization structure

LLCProprietary

Enrollment address

1501 SW Arborwalk Blvd
Lee's Summit, MO 64082-4300

Nursing home name

RAINTREE VILLAGE

Affiliated entity

PIVOTAL HEALTH CARE

Listed as

Raintree VillageCCN 265888 · All quality measures

Type

Medicare and Medicaid

Ownership

For profit - Corporation

Certified

May 2, 2025

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

4031.6 residents per day on average

Chain

Pivotal Health Care9 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

All disclosed owners & managing parties 65

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

Owners & managing parties with NPI records 1

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

• Jessica Nicole Lee, DO

  • Internal Medicine Physician
  • Lee's Summit, MO
  • NPI 1811284607

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Facilities with the same owner 9

Facilities that share an organizational owner with 5% or greater ownership or operational control.

• CCRC of Gladstone, LLC

  dba Linden Woods Village

  • Skilled Nursing Facility
  • Gladstone, MO
  • NPI 1033579578

  Pivotal Health Care LLC, Scenic Development LLC

  CMS ownership
• CCRC of Altoona LLC

  dba Prairie Vista Village

  • Skilled Nursing Facility
  • Altoona, IA
  • NPI 1558799031

  Pivotal Health Care LLC, Scenic Development LLC

  CMS ownership
• CCRC of Ames LLC

  dba Northridge Village

  • Skilled Nursing Facility
  • Ames, IA
  • NPI 1316322704

  Pivotal Health Care LLC, Scenic Development LLC

  CMS ownership
• CCRC of Cedar Rapids, LLC

  dba Terrace Glen Village

  • Skilled Nursing Facility
  • Overland Park, KS
  • NPI 1972041952

  Pivotal Health Care LLC, Scenic Development LLC

  CMS ownership
• CCRC of Grimes, LLC

  dba Kennybrook Village

  • Skilled Nursing Facility
  • Grimes, IA
  • NPI 1013200914

  Pivotal Health Care LLC, Scenic Development LLC

  CMS ownership
• CCRC of Lenexa, LLC

  dba Westchester Village of Lenexa

  • Skilled Nursing Facility
  • Lenexa, KS
  • NPI 1144734088

  Cadet Investment LLC, Pivotal Health Care LLC, Poky - 5R LLC, Scenic Development LLC, Scenic Holdings LLC, WSG LLC

  CMS ownership
• CCRC of Overland Park, LLC

  dba Colonial Village

  • Skilled Nursing Facility
  • Overland Park, KS
  • NPI 1063946143

  Pivotal Health Care LLC, Scenic Development LLC

  CMS ownership
• CCRC of West Des Moines, LLC

  dba Cedar Ridge Village

  • Skilled Nursing Facility
  • West Des Moines, IA
  • NPI 1093286395

  Pivotal Health Care LLC, Scenic Development LLC

  CMS ownership
• Corterra of Wichita, LLC

  • Psychiatric Hospital
  • Wichita, KS
  • NPI 1245949684

  Cadet Investment LLC, Poky - 5R LLC, Scenic Development LLC, Scenic Holdings LLC, WSG LLC

  CMS ownership

Affiliated clinicians 1

Clinicians who list this facility as an affiliation in Medicare Care Compare.

• Jessica Nicole Lee, DO

  • Internal Medicine Physician
  • Lee's Summit, MO
  • NPI 1811284607

  Nursing home

  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1684972800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1742169600000",
    "number": "1205528353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6731 W 121ST ST STE 100",
            "city": "OVERLAND PARK",
            "state": "KS",
            "postal_code": "662092003",
            "telephone_number": "913-890-4780"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1501 SW ARBORWALK BLVD",
            "city": "LEE'S SUMMIT",
            "state": "MO",
            "postal_code": "64082",
            "telephone_number": "913-599-5705",
            "fax_number": "913-890-4789"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CCRC OF LEES SUMMIT, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-05-25",
        "last_updated": "2025-03-17",
        "certification_date": "2025-03-17",
        "status": "A",
        "authorized_official_last_name": "WOOD",
        "authorized_official_first_name": "GILBERT",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "MANAGER OF THE LLC",
        "authorized_official_telephone_number": "913-599-5705"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Raintree Village",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Raintree Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amanda Casey, IBCLC
• Edward Brian Cashman, D.O.
• Casita Home Care LLC (ComForCare Home Care (Lee's Summit))
• Carina Rachel Castilleja, RN, MSN, PMHNP-BC
• Stephan Denis Caye, D.D.S.
• Vicki Kay Cederburg, LCSW, LSCSW, ACSW
• Cejj, Inc (Adjust4Life Wellness Center)
• Centerpointe Behavioral Health Kansas City, LLC (Signature Behavioral Healthcare)
• CH Specialty Services Mo LLC
• John P Chagoyan, PLPC, NCC

• Skilled Nursing Facility in Lee's Summit, MO
• Providers in Lee's Summit, MO by specialty
• Skilled Nursing Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.