Healthcare Provider Details

I. General information

NPI: 1225025554
Provider Name (Legal Business Name): CARRIAGE SQUARE HEALTH CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 03/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4009 GENE FIELD RD
SAINT JOSEPH MO
64506-1864
US

IV. Provider business mailing address

4009 GENE FIELD RD
SAINT JOSEPH MO
64506-1864
US

V. Phone/Fax

Practice location:
  • Phone: 816-364-1526
  • Fax: 816-364-2632
Mailing address:
  • Phone: 816-364-1526
  • Fax: 816-364-2632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number031398
License Number StateMO

VIII. Authorized Official

Name: MR. LARRY A BURFORD
Title or Position: PRESIDENT
Credential:
Phone: 816-364-1526