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NPI Code Detail

MEDICARE: GREGORY RIDGE HEALTH CARE CENTER, L.L.C.

MEDICARE: GREGORY RIDGE HEALTH CARE CENTER, L.L.C.
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 Facility

General Provider Information

NPI Number : 1881048338
Entity Type Code : Organization
Provider Name (Legal Business Name) : GREGORY RIDGE HEALTH CARE CENTER, L.L.C.
Provider Business Mailing Address
First Line : 1869 CRAIG PARK CT
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63146-4122
Country : US
Telephone Number : 314-543-3805
Fax Number :
Provider Business Practice Location Address
First Line : 7001 CLEVELAND AVE
Second Line :
City : KANSAS CITY
State : MO
Zip : 64132-1622
Country : US
Telephone Number : 816-333-0700
Fax Number : 816-333-6687
Authorized Official
Title or Position : IN-HOUSE COUNSEL
Name : MR. ROBERT J CRADDICK
Credential :
Telephone Number : 314-543-3816
Provider Enumeration Date : 04/21/2016
Last Update Date : 04/21/2016

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