Mission Lake Convalescent Center Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

034738 Issued in MO

Legal business name

MISSION LAKE CONVALESCENT CENTER INC.

Doing business as

Timberlake Care Center

Practice address

12110 Holmes Rd
Kansas City, MO 64145-1707

Phone

(816) 941-3006

Fax

(816) 942-8049

NPI assigned

Jun 19, 2006

Organization subpart

No

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

Authorized official

Name

Mr. Loren Rea

Title

President

Phone

(816) 941-3006

Specialties & licenses 3

Addresses

Other identifiers 3

Other names 1

• Timberlake Care Center Doing business as

Locations

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

{
    "created_epoch": "1150675200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1361232000000",
    "number": "1770528986",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12110 HOLMES RD",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641451707",
            "telephone_number": "816-941-3006",
            "fax_number": "816-942-8049"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12110 HOLMES RD",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641451707",
            "telephone_number": "816-941-3006",
            "fax_number": "816-942-8049"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MISSION LAKE CONVALESCENT CENTER INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-19",
        "last_updated": "2013-02-19",
        "status": "A",
        "authorized_official_last_name": "REA",
        "authorized_official_first_name": "LOREN",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "816-941-3006",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "034738",
            "primary": true
        },
        {
            "code": "332BN1400X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Nursing Facility Supplies",
            "state": "MO",
            "license": "032111",
            "primary": false
        },
        {
            "code": "332BP3500X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Parenteral & Enteral Nutrition",
            "state": "MO",
            "license": "032111",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PROVIDER",
            "identifier": "032111",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1770528986",
            "state": "MO"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102084506",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Timberlake Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Roxanna Mirza, M.D.
• Niesha Miser, LPC
• Henry Peter Mishek, MD
• Lauren Mishler, PHARM.D., BCPS
• Brandi Missel, APN
• Mission of Love Adult Day Care Corporation
• Missouri CVS Pharmacy LLC
• Missouri CVS Pharmacy LLC
• Missouri CVS Pharmacy LLC
• Missouri CVS Pharmacy LLC

• Skilled Nursing Facility in Kansas City, MO
• Providers in Kansas City, 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 Feb 19, 2013; 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.