Independence MC, LLC

Primary specialty

Alzheimer Center (Dementia Center)Taxonomy code 311500000X

Legal business name

INDEPENDENCE MC, LLC

Doing business as

Jackson Creek Memory Care

Practice address

19400 E 40TH Street CT S
Independence, MO 64057-1548

Phone

(816) 478-5689

NPI assigned

Jan 10, 2024

Last updated

Aug 21, 2024By 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

John Mitchell

Title

Secretary

Phone

(385) 988-3319

Specialties & licenses 1

Addresses

Other names 1

• Jackson Creek Memory Care Doing business as

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

{
    "created_epoch": "1704844800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1724198400000",
    "number": "1679344402",
    "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": "19400 E 40TH STREET CT S",
            "city": "INDEPENDENCE",
            "state": "MO",
            "postal_code": "640571548",
            "telephone_number": "816-478-5689"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INDEPENDENCE MC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-10",
        "last_updated": "2024-08-21",
        "certification_date": "2024-08-21",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "385-988-3319"
    },
    "taxonomies": [
        {
            "code": "311500000X",
            "taxonomy_group": "",
            "desc": "Alzheimer Center (Dementia Center)",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson Creek Memory Care",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Jackson Creek Memory Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• 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)
• 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)
• Independence Orthodontics, LLC

• Alzheimer Center (Dementia Center) in Independence, MO
• Providers in Independence, MO by specialty
• Alzheimer Center (Dementia Center) in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2024; 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.