Healthcare Provider Details

I. General information

NPI: 1649897851
Provider Name (Legal Business Name): THE GRAND ROYALE SENIOR LIVING COMMUNITY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2020
Last Update Date: 07/03/2020
Certification Date: 07/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 NE KENDALLWOOD PKWY
GLADSTONE MO
64119-1831
US

IV. Provider business mailing address

2900 NE KENDALLWOOD PKWY
GLADSTONE MO
64119-1831
US

V. Phone/Fax

Practice location:
  • Phone: 865-556-6818
  • Fax:
Mailing address:
  • Phone: 865-556-6818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DANIEL R STOCKDALE II
Title or Position: PRESIDENT
Credential:
Phone: 865-566-6818