Provider Demographics
NPI:1235117532
Name:THE RANKEN-JORDAN HOME FOR CONVALESCENT CRIPPLED CHILDREN
Entity Type:Organization
Organization Name:THE RANKEN-JORDAN HOME FOR CONVALESCENT CRIPPLED CHILDREN
Other - Org Name:RANKEN JORDAN - A PEDIATRIC SPECIALTY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:BARDWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-872-6406
Mailing Address - Street 1:11365 DORSETT RD
Mailing Address - Street 2:
Mailing Address - City:MARYLAND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63043-3411
Mailing Address - Country:US
Mailing Address - Phone:314-872-6400
Mailing Address - Fax:314-872-6500
Practice Address - Street 1:11365 DORSETT RD
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-3411
Practice Address - Country:US
Practice Address - Phone:314-872-6400
Practice Address - Fax:314-872-6500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-06
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO472-3282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO011867801Medicaid
IL=========002Medicaid
MO011867801Medicaid