Provider Demographics
NPI:1508910118
Name:CATHEDRAL ROCK OF NORTH ST LOUIS, INC.
Entity Type:Organization
Organization Name:CATHEDRAL ROCK OF NORTH ST LOUIS, INC.
Other - Org Name:CATHEDRAL GARDENS CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:HARRINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-335-4111
Mailing Address - Street 1:306 W 7TH ST STE 415
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-4905
Mailing Address - Country:US
Mailing Address - Phone:817-335-4111
Mailing Address - Fax:817-335-0800
Practice Address - Street 1:2600 REDMAN RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-5863
Practice Address - Country:US
Practice Address - Phone:314-355-8585
Practice Address - Fax:314-355-4645
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CATHEDRAL ROCK CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-22
Last Update Date:2010-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031953314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO107645004Medicaid
MO107645004Medicaid