Provider Demographics
NPI:1760508253
Name:THE REHABILITATION CENTER OF RAYMORE, LLC
Entity Type:Organization
Organization Name:THE REHABILITATION CENTER OF RAYMORE, LLC
Other - Org Name:THE REHABILITATION CENTER OF RAYMORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:T
Authorized Official - Last Name:BERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-468-4752
Mailing Address - Street 1:600 E SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-9037
Mailing Address - Country:US
Mailing Address - Phone:816-322-1991
Mailing Address - Fax:816-322-4810
Practice Address - Street 1:600 E SUNRISE DR
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-9037
Practice Address - Country:US
Practice Address - Phone:816-322-1991
Practice Address - Fax:816-322-4810
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SUMMIT CARE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-22
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO043390310400000X
MO043389314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO102944402Medicaid
MO265476Medicare Oscar/Certification