Provider Demographics
NPI:1902808041
Name:CARONDELET LONG TERM CARE FACILITIES INC
Entity Type:Organization
Organization Name:CARONDELET LONG TERM CARE FACILITIES INC
Other - Org Name:CARONDELET MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:COARY
Authorized Official - Middle Name:WAYNE
Authorized Official - Last Name:HOLMES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-943-4777
Mailing Address - Street 1:621 CARONDELET DR
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4670
Mailing Address - Country:US
Mailing Address - Phone:816-943-4777
Mailing Address - Fax:816-941-7007
Practice Address - Street 1:621 CARONDELET DR
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4670
Practice Address - Country:US
Practice Address - Phone:816-943-4777
Practice Address - Fax:816-941-7007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031121314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
26-5303Medicare ID - Type Unspecified