Healthcare Provider Details

I. General information

NPI: 1881048338
Provider Name (Legal Business Name): GREGORY RIDGE HEALTH CARE CENTER, L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 04/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 CLEVELAND AVE
KANSAS CITY MO
64132-1622
US

IV. Provider business mailing address

1869 CRAIG PARK CT
SAINT LOUIS MO
63146-4122
US

V. Phone/Fax

Practice location:
  • Phone: 816-333-0700
  • Fax: 816-333-6687
Mailing address:
  • Phone: 314-543-3805
  • 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: MR. ROBERT J CRADDICK
Title or Position: IN-HOUSE COUNSEL
Credential:
Phone: 314-543-3816