Healthcare Provider Details

I. General information

NPI: 1184778789
Provider Name (Legal Business Name): CATHEDRAL ROCK OF BALLWIN INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 04/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CHARIC DR
BALLWIN MO
63021-2001
US

IV. Provider business mailing address

306 W 7TH ST STE 415
FT WORTH TX
76102-4905
US

V. Phone/Fax

Practice location:
  • Phone: 636-394-2522
  • Fax: 636-527-2218
Mailing address:
  • Phone: 817-335-4111
  • Fax: 817-335-0800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number031740
License Number StateMO

VIII. Authorized Official

Name: CHARLES KENT HARRINGTON
Title or Position: PRESIDENT
Credential:
Phone: 817-335-4111