Basic Information
| Provider Information | |||||||||
| NPI: | 1093701740 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CATHEDRALROCK | ||||||||
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| Mailing Information | |||||||||
| Address1: | 306 W 7TH ST STE 415 | ||||||||
| Address2: | FORT WORTH CLUB BLDG | ||||||||
| City: | FORT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 76102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173354111 | ||||||||
| FaxNumber: | 8173350800 | ||||||||
| Practice Location | |||||||||
| Address1: | 2840 W CLAY | ||||||||
| Address2: | BLANCHETTE PLACE | ||||||||
| City: | ST CHARLES | ||||||||
| State: | MO | ||||||||
| PostalCode: | 63301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6369466100 | ||||||||
| FaxNumber: | 6369473437 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/27/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HARRINGTON | ||||||||
| AuthorizedOfficialFirstName: | KENT | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8173354111 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 030761 | MO | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 001521 | 01 | MO | STATE FACILITY ID | OTHER |