JACKSON CREEK MEMORY CARE
NPI 1679344402
Alzheimer Center (Dementia Center) in Independence, MO

Q: What is Independence Mc, LLC's NPI number?

The NPI number for Independence Mc, LLC is 1679344402. It was assigned to this organization in the NPPES registry on January 10, 2024. The provider is doing business as Jackson Creek Memory Care.

Q: What is Independence Mc, LLC's specialty?

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

Active since January 10, 2024CLIA 26D1086097 · Waiver

19400 E 40TH STREET CT S, INDEPENDENCE, MO 64057(816) 478-5689 Get Directions Write a Review

NPPES record last updated: August 21, 2024. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Aug 21, 2024, Aug 13, 2024 (2 updates tracked since 2024).

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About Jackson Creek Memory Care NPPES

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

JACKSON CREEK MEMORY CARE (NPI 1679344402) is a healthcare organization registered as an alzheimer center (dementia center) in Independence, Missouri and active in the NPI registry since January 2024. The organization holds a CLIA Waiver certificate valid through July 2, 2028 and lists John Mitchell, Secretary, as its authorized official.

NPPES Registry Identity

NPI1679344402

Entity TypeOrganization

Primary Taxonomy311500000X

Legal Business NameINDEPENDENCE MC, LLC

Location Address19400 E 40TH STREET CT SIndependence, MO 64057-1548

Mailing Address262 N University AveFarmington, UT 84025-2975

Phone(816) 478-5689

Organization SubpartNo

Authorized OfficialJohn MitchellSecretary · (385) 988-3319

Enumeration DateJanuary 10, 2024

Last NPPES UpdateAugust 21, 20242 updates tracked since enumeration

NPPES CertifiedAugust 21, 2024

✔ NPI 1679344402 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 STREET CT S, Independence, MO 64057

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Other Names 1

Doing Business AsJackson 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 26D1086097

Jackson Creek Memory Care · Independence, MO

Active · expires Jul 2, 2028

CLIA Number26D1086097

Laboratory TypeOther

Certificate Effective DateJuly 3, 2026

Certificate Expiration DateJuly 2, 2028

Laboratory DirectorMalathi Tadakamalla

Laboratory Phone(816) 795-1433

Laboratory LocationJackson Creek Memory Care19400 E 40th Ct South, Independence, MO 64057

CLIA data matches this NPI record on: Name

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 Independence Mc, LLC's NPI number?

The NPI number for Independence Mc, LLC is 1679344402. It was assigned to this organization in the NPPES registry on January 10, 2024. The provider is doing business as Jackson Creek Memory Care.

Where is Independence Mc, LLC located?

Independence Mc, LLC is located at 19400 E 40th Street Ct S, Independence, MO 64057. The listed phone number is (816) 478-5689.

What is Independence Mc, LLC's specialty?

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

Does Independence Mc, LLC hold a CLIA laboratory certificate?

Yes. A Certificate of Waiver (number 26D1086097) is associated with this NPI, valid through July 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 Independence Mc, LLC was last updated on August 21, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 23 months 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.