Healthcare Provider Details

I. General information

NPI: 1962498162
Provider Name (Legal Business Name): CATHEDRALROCK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 RANCHO LN
FLORISSANT MO
63031-1717
US

IV. Provider business mailing address

306 W 7TH ST 415 FORT WORTH CLUB BLDG
FORT WORTH TX
76102-4900
US

V. Phone/Fax

Practice location:
  • Phone: 314-839-2150
  • Fax: 314-839-8736
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 Number029559
License Number StateMO

VIII. Authorized Official

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