Provider Demographics
NPI:1356453609
Name:CCRC OPCO - FOXWOOD SPRINGS, LLC
Entity Type:Organization
Organization Name:CCRC OPCO - FOXWOOD SPRINGS, LLC
Other - Org Name:FOXWOOD SPRINGS LIVING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO & PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:W
Authorized Official - Last Name:OHLENDORF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-918-5000
Mailing Address - Street 1:1500 W FOXWOOD DR
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-9347
Mailing Address - Country:US
Mailing Address - Phone:816-331-3111
Mailing Address - Fax:
Practice Address - Street 1:1500 W FOXWOOD DR
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-9372
Practice Address - Country:US
Practice Address - Phone:816-331-3111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BROOKDALE SENIOR LIVING INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2014-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO032980310400000X
MO032979314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101486306Medicaid
MO265803Medicare Oscar/Certification