Hidden Lake SNF Opco, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

HIDDEN LAKE SNF OPCO, LLC

Doing business as

Hidden Lake Care Center

Practice address

11400 Hidden Lake Dr
Raytown, MO 64133-7409

Phone

(816) 737-1010

NPI assigned

Jun 26, 2020

Organization subpart

No

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

Authorized official

Name

Mary Beth Hundley

Title

Chief Accounting Officer

Phone

(863) 259-9800

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Hidden Lake Care Center Doing business as

Electronic endpoints 1

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

{
    "created_epoch": "1593129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1595289600000",
    "number": "1245857135",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20 3RD ST SW STE 308",
            "city": "WINTER HAVEN",
            "state": "FL",
            "postal_code": "338802969"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11400 HIDDEN LAKE DR",
            "city": "RAYTOWN",
            "state": "MO",
            "postal_code": "641337409",
            "telephone_number": "816-737-1010"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIDDEN LAKE SNF OPCO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-06-26",
        "last_updated": "2020-07-21",
        "certification_date": "2020-07-21",
        "status": "A",
        "authorized_official_last_name": "HUNDLEY",
        "authorized_official_first_name": "MARY BETH",
        "authorized_official_title_or_position": "CHIEF ACCOUNTING OFFICER",
        "authorized_official_telephone_number": "863-259-9800"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103256202",
            "state": "MO"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "PointClickCare",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "11400 Hidden Lake Dr",
            "city": "Raytown",
            "state": "MO",
            "country_code": "US",
            "postal_code": "641337409",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "organization_name": "Hidden Lake Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Richard L. Hess
• Douglas Hickman
• Levearn Hicks
• Taci Hicks, LCSW
• Hidden Lake Management LLC (Hidden Lake Care Center)
• Alicia Hill Taylor
• Brian Eric Hill, LSCSW
• Lou A Hill, NP-C
• Amy Hinds, OTR/L
• Emily Madelyn Hines

• Skilled Nursing Facility in Raytown, MO
• Providers in Raytown, 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 Jul 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.