Healthcare Provider Details

I. General information

NPI: 1609121912
Provider Name (Legal Business Name): RAVINDER GOSWAMI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2012
Last Update Date: 07/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1080 NW SOUTH OUTER RD
BLUE SPRINGS MO
64015-3087
US

IV. Provider business mailing address

5311 NW 60TH ST
KANSAS CITY MO
64151-4381
US

V. Phone/Fax

Practice location:
  • Phone: 816-228-5335
  • Fax:
Mailing address:
  • Phone: 816-569-0563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2009024411
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number2009024411
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number0435222
License Number StateKS
# 4
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number0435222
License Number StateKS
# 5
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number2009024411
License Number StateMO
# 6
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0435222
License Number StateKS

VIII. Authorized Official

Name: DR. RAVINDER GOSWAMI
Title or Position: OWNER
Credential: M.D
Phone: 816-569-0563