Healthcare Provider Details

I. General information

NPI: 1245230689
Provider Name (Legal Business Name): BLUE RIVER CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10425 CHESTNUT DR
KANSAS CITY MO
64137-3201
US

IV. Provider business mailing address

10425 CHESTNUT DR
KANSAS CITY MO
64137-3201
US

V. Phone/Fax

Practice location:
  • Phone: 816-763-4444
  • Fax: 816-763-4777
Mailing address:
  • Phone: 816-763-4444
  • Fax: 816-763-4777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number030243
License Number StateMO

VIII. Authorized Official

Name: MS. MARY THURBER
Title or Position: CORPORATE ADMINISTRATOR
Credential:
Phone: 816-763-4444