Provider Demographics
NPI:1396959045
Name:BLUE RIDGE NURSING HOME
Entity type:Organization
Organization Name:BLUE RIDGE NURSING HOME
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:JR
Authorized Official - Credentials:RN
Authorized Official - Phone:816-365-5433
Mailing Address - Street 1:7505 E 87TH ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64138-3917
Mailing Address - Country:US
Mailing Address - Phone:816-761-6838
Mailing Address - Fax:
Practice Address - Street 1:7505 E 87TH ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64138-3917
Practice Address - Country:US
Practice Address - Phone:816-761-6838
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO033937313M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes313M00000XNursing & Custodial Care FacilitiesNursing Facility/Intermediate Care Facility