Healthcare Provider Details

I. General information

NPI: 1205883915
Provider Name (Legal Business Name): BLC-FOXWOOD SPRINGS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 W FOXWOOD DR
RAYMORE MO
64083-9347
US

IV. Provider business mailing address

1500 W FOXWOOD DR
RAYMORE MO
64083-9347
US

V. Phone/Fax

Practice location:
  • Phone: 816-331-3111
  • Fax: 816-331-2490
Mailing address:
  • Phone: 816-331-3111
  • Fax: 816-331-2490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number032458
License Number StateMO

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. MARK JORDAN SCHULTE
Title or Position: CEO
Credential:
Phone: 312-977-3700