KMJ Enterprises Cassville LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

031016 Issued in MO

Legal business name

KMJ ENTERPRISES CASSVILLE LLC

Doing business as

Red Rose Health and Rehabilitation Center

Practice address

812 Old Exeter Rd
Cassville, MO 65625-1704

Phone

(417) 847-2184

Fax

(417) 847-2642

NPI assigned

Sep 30, 2005

Last updated

Jan 20, 2012By the provider in NPPES

Organization subpart

Yes

Parent organization

KMJ MANAGEMENTAs reported in NPPES

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

Authorized official

Name

Jacqueline Michele Rose Hathorn

Title

Managing Member

Phone

(479) 636-5716

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Red Rose Health and Rehabilitation Center Doing business as

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

{
    "created_epoch": "1128038400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1327017600000",
    "number": "1487641841",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 HALSTED CIR",
            "city": "ROGERS",
            "state": "AR",
            "postal_code": "727563185",
            "telephone_number": "479-636-5716",
            "fax_number": "479-636-2080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "812 OLD EXETER RD",
            "city": "CASSVILLE",
            "state": "MO",
            "postal_code": "656251704",
            "telephone_number": "417-847-2184",
            "fax_number": "417-847-2642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KMJ ENTERPRISES CASSVILLE LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "KMJ MANAGEMENT",
        "enumeration_date": "2005-09-30",
        "last_updated": "2012-01-20",
        "status": "A",
        "authorized_official_last_name": "ROSE HATHORN",
        "authorized_official_first_name": "JACQUELINE",
        "authorized_official_middle_name": "MICHELE",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "479-636-5716"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "031016",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "26A159",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Red Rose Health and Rehabilitation Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Cassville, MO
• Providers in Cassville, 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 Jan 20, 2012; 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.