1891814117 NPI number — NORTHSTAR RESIDENTIAL CARE, INC.

Table of content: (NPI 1891814117)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891814117 NPI number — NORTHSTAR RESIDENTIAL CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTHSTAR RESIDENTIAL CARE, INC.
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:
Provider Other Organization Name Type Code:
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:
1891814117
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18805 HANTHORNE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDEPENDENCE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64057-1676
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-795-7652
Provider Business Mailing Address Fax Number:
816-795-0163

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 SW 6TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLUE SPRINGS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-795-7652
Provider Business Practice Location Address Fax Number:
816-795-0163
Provider Enumeration Date:
03/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NORTH
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
BRADLEY
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
816-795-7652

Provider Taxonomy Codes

  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com