Provider Demographics
NPI:1093712549
Name:LIVING COMMUNITY OF ST. JOSEPH
Entity Type:Organization
Organization Name:LIVING COMMUNITY OF ST. JOSEPH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:KERNS
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:816-671-8503
Mailing Address - Street 1:1202 HEARTLAND RD
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3200
Mailing Address - Country:US
Mailing Address - Phone:816-671-8500
Mailing Address - Fax:816-671-8571
Practice Address - Street 1:1202 HEARTLAND RD
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-3200
Practice Address - Country:US
Practice Address - Phone:816-671-8500
Practice Address - Fax:816-671-8571
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENEDICTINE HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-30
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO030176314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101499002Medicaid
MO101499002Medicaid