Healthcare Provider Details

I. General information

NPI: 1770403974
Provider Name (Legal Business Name): MEADOW RIDGE GARDENS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 MEADOW RIDGE LN
MOBERLY MO
65270-4549
US

IV. Provider business mailing address

1805 NW PLATTE RD STE 100
RIVERSIDE MO
64150-7500
US

V. Phone/Fax

Practice location:
  • Phone: 660-263-0550
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: CHAIM MANDELBAUM
Title or Position: MEDICARE AUTHORIZED OFFICIAL
Credential:
Phone: 816-429-0850