Provider Demographics
NPI:1245230689
Name:BLUE RIVER CARE CENTER, LLC
Entity Type:Organization
Organization Name:BLUE RIVER CARE CENTER, LLC
Other - Org Name:BLUE RIVER CARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CORPORATE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:THURBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-763-4444
Mailing Address - Street 1:10425 CHESTNUT DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64137-3201
Mailing Address - Country:US
Mailing Address - Phone:816-763-4444
Mailing Address - Fax:816-763-4777
Practice Address - Street 1:10425 CHESTNUT DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64137-3201
Practice Address - Country:US
Practice Address - Phone:816-763-4444
Practice Address - Fax:816-763-4777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO030243314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOD08605687OtherDMERC MEDICARE SUBMITTER
MOD08605687OtherDMERC MEDICARE SUBMITTER