Basic Information
| Provider Information | |||||||||
| NPI: | 1205883915 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BLC-FOXWOOD SPRINGS, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | FOXWOOD SPRINGS LIVING CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 W FOXWOOD DR | ||||||||
| Address2: | |||||||||
| City: | RAYMORE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640839347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163313111 | ||||||||
| FaxNumber: | 8163312490 | ||||||||
| Practice Location | |||||||||
| Address1: | 1500 W FOXWOOD DR | ||||||||
| Address2: | |||||||||
| City: | RAYMORE | ||||||||
| State: | MO | ||||||||
| PostalCode: | 640839347 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163313111 | ||||||||
| FaxNumber: | 8163312490 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/28/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | SCHULTE | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | JORDAN | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3129773700 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 032458 | MO | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.