Provider Demographics
NPI:1568466076
Name:KJD INCORPORATED
Entity Type:Organization
Organization Name:KJD INCORPORATED
Other - Org Name:THE RIVERVIEW
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DAIGGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-353-5900
Mailing Address - Street 1:5500 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63111-2025
Mailing Address - Country:US
Mailing Address - Phone:314-353-5900
Mailing Address - Fax:314-353-5907
Practice Address - Street 1:5500 S BROADWAY
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63111-2025
Practice Address - Country:US
Practice Address - Phone:314-353-5900
Practice Address - Fax:314-353-5907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2009-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031300310400000X
MO031299314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO179678OtherBLUE CROSS BLUE SHIELD
MO107837106Medicaid
MO265751Medicare Oscar/Certification