1457395782 NPI number — BEAUTIFUL SAVIOR HOME

Table of content: (NPI 1457395782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457395782 NPI number — BEAUTIFUL SAVIOR HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BEAUTIFUL SAVIOR HOME
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BEAUTIUL SAVIOR LUTHERAN HOME
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457395782
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1003 S CEDAR ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELTON
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64012-3703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-331-0781
Provider Business Mailing Address Fax Number:
816-322-4975

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1003 S CEDAR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BELTON
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64012-3703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-331-0781
Provider Business Practice Location Address Fax Number:
816-322-4975
Provider Enumeration Date:
06/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BUFORD
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
LOUISE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
816-331-0781

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  031842 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X , with the licence number: 031841 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 101479608 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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