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General NPI Number Information
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NPI Number | 1457395782
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Entity Type | Organization
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Legal Business Name | BEAUTIFUL SAVIOR HOME
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Dates
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Enumeration Date | 06/16/2006
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Last Update Date | 03/22/2012
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Provider Practice Location Address
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Address Line | 1003 S CEDAR ST
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City | BELTON
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State | MO
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Zip | 64012-3703
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Country | US
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Telephone | 816-331-0781
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Fax | 816-322-4975
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Provider Business Mailing Address
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Address Line | 1003 S CEDAR ST
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City | BELTON
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State | MO
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Zip | 64012-3703
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Country | US
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Telephone | 816-331-0781
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Fax | 816-322-4975
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. BRENDA LOUISE BUFORD
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Credential |
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Telephone | 816-331-0781
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 031842
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 031841
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License Number State | MO
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