Healthcare Provider Details

I. General information

NPI: 1093701740
Provider Name (Legal Business Name): CATHEDRALROCK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2840 W CLAY BLANCHETTE PLACE
ST CHARLES MO
63301
US

IV. Provider business mailing address

306 W 7TH ST STE 415 FORT WORTH CLUB BLDG
FORT WORTH TX
76102
US

V. Phone/Fax

Practice location:
  • Phone: 636-946-6100
  • Fax: 636-947-3437
Mailing address:
  • Phone: 817-335-4111
  • Fax: 817-335-0800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number030761
License Number StateMO

VIII. Authorized Official

Name: KENT HARRINGTON
Title or Position: PRESIDENT
Credential:
Phone: 817-335-4111