MEDICARE: BLUE RIDGE NURSING HOME

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
1	313M00000X	Nursing Facility/Intermediate Care Facility	033937	MO

General Provider Information

NPI Number	:	1396959045
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLUE RIDGE NURSING HOME

Provider Business Mailing Address
First Line	:	7505 E 87TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64138-3917
Country	:	US
Telephone Number	:	816-761-6838
Fax Number	:

Provider Business Practice Location Address
First Line	:	7505 E 87TH ST
Second Line	:
City	:	KANSAS CITY
State	:	MO
Zip	:	64138-3917
Country	:	US
Telephone Number	:	816-761-6838
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. FRANK WILLIAM CARROLL JR.
Credential	:	RN
Telephone Number	:	816-365-5433

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	08/22/2020

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Directions to “BLUE RIDGE NURSING HOME ” Practice Location

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