Provider Demographics
NPI:1154073351
Name:RAYMORE MO CONSULTING LLC
Entity Type:Organization
Organization Name:RAYMORE MO CONSULTING LLC
Other - Org Name:POLARIS HEALTH & WELLNESS OF RAYMORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED PERSON
Authorized Official - Prefix:
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:516-727-1634
Mailing Address - Street 1:525 CHESTNUT ST STE 102
Mailing Address - Street 2:
Mailing Address - City:CEDARHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11516-2223
Mailing Address - Country:US
Mailing Address - Phone:516-727-1634
Mailing Address - Fax:
Practice Address - Street 1:600 E SUNRISE DR
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-9037
Practice Address - Country:US
Practice Address - Phone:816-322-1991
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-19
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility