Healthcare Provider Details

I. General information

NPI: 1649808577
Provider Name (Legal Business Name): IGNITE MEDICAL RESORT CARONDELET, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2020
Last Update Date: 01/29/2021
Certification Date: 01/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 CARONDELET DR
KANSAS CITY MO
64114-4670
US

IV. Provider business mailing address

1550 N NORTHWEST HWY STE 430
PARK RIDGE IL
60068-1411
US

V. Phone/Fax

Practice location:
  • Phone: 816-941-1300
  • Fax:
Mailing address:
  • Phone: 833-944-6483
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TIMOTHY FIELDS
Title or Position: CEO
Credential:
Phone: 833-944-6483