Healthcare Provider Details

I. General information

NPI: 1922094523
Provider Name (Legal Business Name): BB&K, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 10/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3260 BAISCH DR
DE SOTO MO
63020-5046
US

IV. Provider business mailing address

3260 BAISCH DR
DE SOTO MO
63020-5046
US

V. Phone/Fax

Practice location:
  • Phone: 636-586-2291
  • Fax: 636-586-2292
Mailing address:
  • Phone: 636-586-2291
  • Fax: 636-586-2292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number031516
License Number StateMO

VIII. Authorized Official

Name: MR. BRUCE WARREN BAISCH
Title or Position: ADMINISTRATOR/C.E.O.
Credential:
Phone: 636-586-2291