Independence Community Healthcare, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

INDEPENDENCE COMMUNITY HEALTHCARE, LLC

Doing business as

Jackson Creek Post Acute

Practice address

3980 S Jackson Dr
Independence, MO 64057-2205

Phone

(816) 795-1433

NPI assigned

Jan 10, 2024

Organization subpart

No

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

Authorized official

Name

Alicia Torres

Title

Manager

Phone

(385) 342-5175

Specialties & licenses 2

Addresses

Other names 1

• Jackson Creek Post Acute Doing business as

Medicare fee-for-service enrollment

Enrolled in MO

Enrollment records 1

Skilled nursing facility certification: CCN 265820

Legal name

INDEPENDENCE COMMUNITY HEALTHCARE LLC

Doing business as

VILLAGES OF JACKSON CREEK

Certification status

Active

Provider type (POS)

Nursing home – SNF/NF dual certification

Participating since

Feb 22, 2008

Last certification

May 7, 2024

Beds

120

Ownership / control type

Limited Liability Corporation

Organization structure

LLCProprietary

Incorporated

Aug 2, 2023 in MO

Enrollment address

3980 S. Jackson Drive
Independence, MO 64057-2205

Nursing home name

VILLAGES OF JACKSON CREEK

Affiliated entity

PACS GROUP

Listed as

Villages of Jackson CreekCCN 265820 · All quality measures

Overall star rating

2 of 5

Health inspections

2 of 5

Staffing

2 of 5

Quality measures

4 of 5

Type

Medicare and Medicaid

Ownership

For profit - Limited Liability company

Certified

Feb 22, 2008

Medicare certification status

ActiveFrom the Provider of Services file

Certified beds

120106.6 residents per day on average

Chain

Pacs Group274 facilities in the chain

Penalties (3 years)

1Fines totaling $29,186

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

All disclosed owners & managing parties 15

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.

• Sol Allan Enriquez

  • Hospitalist Physician
  • Independence, MO
  • NPI 1699769356

  Adp of the SNF, Operational/Managerial Control

  CMS ownership

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• William F Sudholt, D.O.

  • Internal Medicine Physician
  • Blue Springs, MO
  • NPI 1164486254
  NPD (past)
• Srinath Tadakamalla, M.D

  • Geriatric Medicine (Family Medicine) Physician
  • Harrisonville, MO
  • NPI 1184691305
  NPD (past)
• Haseeb Abdul Ahmed, DO

  • Internal Medicine Physician
  • Overland Park, KS
  • NPI 1972701571
  NPD (past)

Affiliated clinicians 2

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

• William F Sudholt, D.O.

  • Internal Medicine Physician
  • Blue Springs, MO
  • NPI 1164486254

  Nursing home

  Care Compare affiliation
• Haseeb Abdul Ahmed, DO

  • Internal Medicine Physician
  • Overland Park, KS
  • NPI 1972701571

  Nursing home

  Care Compare affiliation

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

{
    "created_epoch": "1704844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1736121600000",
    "number": "1639940521",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "262 N UNIVERSITY AVE",
            "city": "FARMINGTON",
            "state": "UT",
            "postal_code": "840252975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3980 S JACKSON DR",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640572205",
            "telephone_number": "816-795-1433"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENCE COMMUNITY HEALTHCARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-10",
        "last_updated": "2025-01-06",
        "certification_date": "2025-01-02",
        "status": "A",
        "authorized_official_last_name": "TORRES",
        "authorized_official_first_name": "ALICIA",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "385-342-5175"
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson Creek Post Acute",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jackson Creek Post Acute",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Inclusions LLC
• Independence 1 Inc (Maywood Terrace Living Center)
• Independence Anesthesia Inc
• Independence ASC LLC (The Endoscopy Center - East)
• Independence Avenue Dental LLC (True Dental Group)
• 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 Manor Inc (Independence Manor Care Center)

• 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 Jan 6, 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.