Provider Demographics
NPI:1821144098
Name:BSLC II
Entity Type:Organization
Organization Name:BSLC II
Other - Org Name:THE GARDENS AT BARRY ROAD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSISTANT SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:HARBACH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:719-650-7757
Mailing Address - Street 1:8300 NW BARRY RD
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64153-1634
Mailing Address - Country:US
Mailing Address - Phone:816-584-3200
Mailing Address - Fax:816-584-3201
Practice Address - Street 1:8300 NW BARRY RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64153-1634
Practice Address - Country:US
Practice Address - Phone:816-584-3200
Practice Address - Fax:816-584-3201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-28
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO030852310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO266257401Medicaid