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NPI Code Detail

MEDICARE: CARONDELET LONG TERM CARE FACILITIES, INC.

MEDICARE: CARONDELET LONG TERM CARE FACILITIES, INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility031289MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1710979836
Entity Type Code : Organization
Provider Name (Legal Business Name) : CARONDELET LONG TERM CARE FACILITIES, INC.
Provider Business Mailing Address
First Line : 111 NW MOCK AVE
Second Line :
City : BLUE SPRINGS
State : MO
Zip : 64014-2503
Country : US
Telephone Number : 816-228-5655
Fax Number : 816-228-8480
Provider Business Practice Location Address
First Line : 111 NW MOCK AVE
Second Line :
City : BLUE SPRINGS
State : MO
Zip : 64014-2503
Country : US
Telephone Number : 816-228-5655
Fax Number : 816-228-8480
Authorized Official
Title or Position : ADMINISTRATOR, CEO
Name : MR. ANTHONY COLUMBATTO
Credential :
Telephone Number : 816-228-5655
Provider Enumeration Date : 08/16/2005
Last Update Date : 10/27/2014

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