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NPI Code Detail

MEDICARE: BLUE RIVER CARE CENTER, LLC

MEDICARE: BLUE RIVER CARE CENTER, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility030243MO

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1D08605687OTHERMODMERC MEDICARE SUBMITTER

General Provider Information

NPI Number : 1245230689
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLUE RIVER CARE CENTER, LLC
Provider Business Mailing Address
First Line : 10425 CHESTNUT DR
Second Line :
City : KANSAS CITY
State : MO
Zip : 64137-3201
Country : US
Telephone Number : 816-763-4444
Fax Number : 816-763-4777
Provider Business Practice Location Address
First Line : 10425 CHESTNUT DR
Second Line :
City : KANSAS CITY
State : MO
Zip : 64137-3201
Country : US
Telephone Number : 816-763-4444
Fax Number : 816-763-4777
Authorized Official
Title or Position : CORPORATE ADMINISTRATOR
Name : MS. MARY THURBER
Credential :
Telephone Number : 816-763-4444
Provider Enumeration Date : 07/28/2005
Last Update Date : 08/22/2020

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Directions to “BLUE RIVER CARE CENTER, LLC ” Practice Location

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