Provider Demographics
NPI:1477630408
Name:STRATFORD HEALTH CARE GROUP, INC
Entity Type:Organization
Organization Name:STRATFORD HEALTH CARE GROUP, INC
Other - Org Name:HIDDEN LAKE CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:RAE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LETTERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-595-1834
Mailing Address - Street 1:PO BOX 16567
Mailing Address - Street 2:
Mailing Address - City:RAYTOWN
Mailing Address - State:MO
Mailing Address - Zip Code:64133-0567
Mailing Address - Country:US
Mailing Address - Phone:816-737-1010
Mailing Address - Fax:816-595-1861
Practice Address - Street 1:11400 HIDDEN LAKE DR
Practice Address - Street 2:
Practice Address - City:RAYTOWN
Practice Address - State:MO
Practice Address - Zip Code:64133-7409
Practice Address - Country:US
Practice Address - Phone:816-737-1010
Practice Address - Fax:816-737-0359
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031364310400000X
MO032518313M00000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO263256208OtherPERSONAL CARE NUMBER
MO103256202Medicaid
MO263256208OtherPERSONAL CARE NUMBER