1235117532 NPI number — THE RANKEN-JORDAN HOME FOR CONVALESCENT CRIPPLED CHILDREN

Table of content: (NPI 1235117532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235117532 NPI number — THE RANKEN-JORDAN HOME FOR CONVALESCENT CRIPPLED CHILDREN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE RANKEN-JORDAN HOME FOR CONVALESCENT CRIPPLED CHILDREN
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:
RANKEN JORDAN - A PEDIATRIC SPECIALTY HOSPITAL
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:
1235117532
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11365 DORSETT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MARYLAND HEIGHTS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
63043-3411
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
314-872-6400
Provider Business Mailing Address Fax Number:
314-872-6500

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11365 DORSETT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARYLAND HEIGHTS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63043-3411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-872-6400
Provider Business Practice Location Address Fax Number:
314-872-6500
Provider Enumeration Date:
01/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BARDWELL
Authorized Official First Name:
JEAN
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
314-872-6406

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  472-3 , 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: 011867801 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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