Basic Information
| Provider Information | |||||||||
| NPI: | 1881048338 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GREGORY RIDGE HEALTH CARE CENTER, L.L.C. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1869 CRAIG PARK CT | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631464122 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3145433805 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7001 CLEVELAND AVE | ||||||||
| Address2: | |||||||||
| City: | KANSAS CITY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 641321622 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8163330700 | ||||||||
| FaxNumber: | 8163336687 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2016 | ||||||||
| LastUpdateDate: | 04/21/2016 | ||||||||
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| AuthorizedOfficialLastName: | CRADDICK | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | IN-HOUSE COUNSEL | ||||||||
| AuthorizedOfficialTelephone: | 3145433816 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.