Provider Demographics
NPI:1457395782
Name:BEAUTIFUL SAVIOR HOME
Entity Type:Organization
Organization Name:BEAUTIFUL SAVIOR HOME
Other - Org Name:BEAUTIUL SAVIOR LUTHERAN HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:BUFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-331-0781
Mailing Address - Street 1:1003 S CEDAR ST
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:MO
Mailing Address - Zip Code:64012-3703
Mailing Address - Country:US
Mailing Address - Phone:816-331-0781
Mailing Address - Fax:816-322-4975
Practice Address - Street 1:1003 S CEDAR ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:MO
Practice Address - Zip Code:64012-3703
Practice Address - Country:US
Practice Address - Phone:816-331-0781
Practice Address - Fax:816-322-4975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031842310400000X
MO031841314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101479608Medicaid
MO101479608Medicaid