Independence Manor Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

002374 Issued in MO

Legal business name

INDEPENDENCE MANOR INC

Doing business as

Independence Manor Care Center

Practice address

1600 S Kings Highway
Independence, MO 64055

Phone

(816) 833-4777

Fax

(816) 833-3032

NPI assigned

Sep 13, 2006

Last updated

Jul 5, 2012By 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

Mr. Hal Juckette

Title

Owner

Phone

(660) 646-5385

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Independence Manor Care Center 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 1255436556. Details of each certification follow.

• CCN 265682 Skilled nursing facility · Active · Details

Skilled nursing facility certification: CCN 265682

Legal name

INDEPENDENCE MANOR INC

Doing business as

INDEPENDENCE MANOR CARE CENTER

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Nov 1, 1997

Last certification

Dec 11, 2023

Beds

99

Ownership / control type

Corporation

Multi-facility organization

Juckette Management Services, Inc

Organization structure

CorporationProprietary

Enrollment address

1600 S Kings Hwy
Independence, MO 64055-1853

Nursing home name

INDEPENDENCE MANOR CARE CENTER

Affiliated entity

JUCKETTE FAMILY HOMES

Listed as

Independence Manor Care CenterCCN 265682 · All quality measures

Overall star rating

3 of 5

Health inspections

3 of 5

Staffing

3 of 5

Quality measures

2 of 5

Type

Medicare and Medicaid

Ownership

For profit - Corporation

Certified

Nov 1, 1997

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

9941.1 residents per day on average

Chain

Juckette Family Homes6 facilities in the chain

Processed by Care Compare on Aug 1, 2026.

All disclosed owners & managing parties 16

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.

• Louay K. Sabih, M.D.

  • Internal Medicine Physician
  • Overland Park, KS
  • NPI 1003800459

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Facilities with the same owner 5

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

• Fulton Manor Inc

  dba Fulton Manor Care Center

  • Skilled Nursing Facility
  • Fulton, MO
  • NPI 1659476141

  Juckette Management Services Inc

  CMS ownership
• Kirksville Manor Inc

  dba Kirksville Manor Care Center

  • Skilled Nursing Facility
  • Kirksville, MO
  • NPI 1255436747

  Juckette Management Services Inc

  CMS ownership
• Livingston Manor Inc

  dba Livingston Manor Care Center

  • Skilled Nursing Facility
  • Chillicothe, MO
  • NPI 1740385228

  Juckette Management Services Inc

  CMS ownership
• Pleasant Valley Manor Inc

  dba Pleasant Valley Manor Care Center

  • Skilled Nursing Facility
  • Liberty, MO
  • NPI 1295830776

  Juckette Management Services Inc

  CMS ownership
• Warrensburg Manor Inc

  dba Warrensburg Manor Care Center

  • Skilled Nursing Facility
  • Warrensburg, MO
  • NPI 1801991104

  Juckette Management Services Inc

  CMS ownership

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Malathi Tadakamalla, M.D.

  • Geriatric Medicine (Family Medicine) Physician
  • Lee's Summit, MO
  • NPI 1316989197
  NPD (past)
• Srinath Tadakamalla, M.D

  • Geriatric Medicine (Family Medicine) Physician
  • Harrisonville, MO
  • NPI 1184691305
  NPD (past)
• Louay K. Sabih, M.D.

  • Internal Medicine Physician
  • Overland Park, KS
  • NPI 1003800459
  NPD (past)

Affiliated clinicians 1

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

• Malathi Tadakamalla, M.D.

  • Geriatric Medicine (Family Medicine) Physician
  • Lee's Summit, MO
  • NPI 1316989197

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1158105600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341446400000",
    "number": "1255436556",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 S KINGS HIGHWAY",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "64055",
            "telephone_number": "816-833-4777",
            "fax_number": "816-833-3032"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 S KINGS HIGHWAY",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "64055",
            "telephone_number": "816-833-4777",
            "fax_number": "816-833-3032"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENCE MANOR INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-13",
        "last_updated": "2012-07-05",
        "status": "A",
        "authorized_official_last_name": "JUCKETTE",
        "authorized_official_first_name": "HAL",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "660-646-5385",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "002374",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "107808503",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Independence Manor Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Independence Community Healthcare, LLC (Jackson Creek Post Acute)
• Independence Fire Department
• Independence Group Health, LLC
• Independence Healthcare LLC (Abode Health and Wellness Center)
• Independence II Operations, LLC (The Villages of Jackson Creek Memory Care)
• Independence MC, LLC (Jackson Creek Memory Care)
• Independence Medical Group PC
• Independence Mo Consulting LLC (Polaris Health & Wellness of Independence)
• Independence Neurosurgery Services LLC (Midwest Brain and Spine Associates)
• Independence Operations LLC (The Villages of Jackson Creek)

• Skilled Nursing Facility in Independence, MO
• Providers in Independence, 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 5, 2012; 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.