Hidden Lake Management LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

HIDDEN LAKE MANAGEMENT LLC

Doing business as

Hidden Lake Care Center

Practice address

11400 Hidden Lake Dr
Raytown, MO 64133-7409

Phone

(816) 737-1010

Fax

(816) 737-3022

NPI assigned

Jul 17, 2012

Organization subpart

No

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

Authorized official

Name

Judah Bienstock

Title

Managing Member

Phone

(314) 812-2550

Specialties & licenses 1

Addresses

Other names 1

• Hidden Lake Care Center Doing business as

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

{
    "created_epoch": "1342483200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1449014400000",
    "number": "1467707380",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11400 HIDDEN LAKE DR",
            "city": "RAYTOWN",
            "state": "MO",
            "postal_code": "641337409",
            "telephone_number": "816-737-1010",
            "fax_number": "816-737-3022"
        },
        {
            "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",
            "fax_number": "816-737-3022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HIDDEN LAKE MANAGEMENT LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-07-17",
        "last_updated": "2015-12-02",
        "status": "A",
        "authorized_official_last_name": "BIENSTOCK",
        "authorized_official_first_name": "JUDAH",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "314-812-2550"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hidden Lake Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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

• 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 Dec 2, 2015; 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.