THE VILLAGES OF JACKSON CREEK MEMORY CARE
NPI 1205259512
Alzheimer Center (Dementia Center) in Independence, MO

Q: What is Villages Of Jackson Creek Memory Care LLC's specialty?

The primary specialty registered for this NPI is Alzheimer Center (Dementia Center) with taxonomy code 311500000X.

Active since January 23, 2014CLIA 26D1078200 · Waiver

19400 E 40TH ST CT, INDEPENDENCE, MO 64057(816) 795-1433 Get Directions Write a Review

NPPES record last updated: January 23, 2014. Verified against the NPPES registry weekly; last sync: October 04, 2026.

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About The Villages Of Jackson Creek Memory Care NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

THE VILLAGES OF JACKSON CREEK MEMORY CARE (NPI 1205259512) is a healthcare organization registered as an alzheimer center (dementia center) in Independence, Missouri and active in the NPI registry since January 2014. The organization holds a CLIA Waiver certificate valid through January 2, 2028 and lists Melvin J Rector, Manager Of Llc, as its authorized official.

NPPES Registry Identity

NPI1205259512

Entity TypeOrganization

Primary Taxonomy311500000X

Legal Business NameVILLAGES OF JACKSON CREEK MEMORY CARE LLC

Location Address19400 E 40TH ST CTIndependence, MO 64057-1548

Mailing Address19400 E 40th St CtIndependence, MO 64057-1548

Phone(816) 795-1433

Organization SubpartYesParent: National Healthcare Corporation

Authorized OfficialMelvin J RectorManager Of Llc · (636) 946-3677

Enumeration DateJanuary 23, 2014

✔ NPI 1205259512 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyAlzheimer Center (Dementia Center)Nursing & Custodial Care Facilities

Taxonomy Code311500000X

Definition

A freestanding facility or special care unit of a long term care facility focusing on patient care of individuals diagnosed with dementia or Alzheimer's Disease or their related diseases. Six elements of the facility/unit set it apart from other (the rest of the) facilities(y): Admission of residents with dementia (including those with Alzheimer's disease); Staff who are specially selected, trained, and supervised; Activities that are specifically designed for the cognitively impaired; A marketing of a special care unit in brochures; A high level of family involvement; and A physical environment designed to keep residents safe and segregated from other populations.

19400 E 40TH ST CT, Independence, MO 64057

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Other Names 1

Doing Business AsThe Villages Of Jackson Creek Memory Care

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate of Waiver 26D1078200

Villages Of Jackson Creek · Independence, MO

Active · expires Jan 2, 2028

CLIA Number26D1078200

Laboratory TypeSkilled Nursing Facility/Nursing Facility

Certificate Effective DateJanuary 3, 2026

Certificate Expiration DateJanuary 2, 2028

Laboratory DirectorHaseeb Ahmed

Laboratory Phone(816) 795-1433

Laboratory LocationVillages Of Jackson Creek3980 S Jackson Drive, Independence, MO 64057

CLIA data matches this NPI record on: Name Phone

This certificate is issued to a laboratory to perform only waived tests.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Villages Of Jackson Creek Memory Care LLC's NPI number?

The NPI number for Villages Of Jackson Creek Memory Care LLC is 1205259512. It was assigned to this organization in the NPPES registry on January 23, 2014. The provider is doing business as The Villages Of Jackson Creek Memory Care.

Where is Villages Of Jackson Creek Memory Care LLC located?

Villages Of Jackson Creek Memory Care LLC is located at 19400 E 40th St Ct, Independence, MO 64057. The listed phone number is (816) 795-1433.

What is Villages Of Jackson Creek Memory Care LLC's specialty?

The primary specialty registered for this NPI is Alzheimer Center (Dementia Center) with taxonomy code 311500000X.

Does Villages Of Jackson Creek Memory Care LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 26D1078200) is associated with this NPI, valid through January 2, 2028. CLIA certificates authorize laboratory testing under the federal Clinical Laboratory Improvement Amendments program.

When was this NPI record last updated?

The NPPES record for Villages Of Jackson Creek Memory Care LLC was last updated on January 23, 2014. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 12 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.