Healthcare Provider Details

I. General information

NPI: 1245154590
Provider Name (Legal Business Name): RAYTOWN OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

9110 E 63RD ST
RAYTOWN MO
64133-4804
US

IV. Provider business mailing address

9110 E 63RD ST
RAYTOWN MO
64133-4804
US

V. Phone/Fax

Practice location:
  • Phone: 636-981-6744
  • Fax:
Mailing address:
  • Phone: 636-981-6744
  • 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: LORETTA LEBAR
Title or Position: COUNSEL
Credential: JD
Phone: 502-419-2571