Ballwin Health Care LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

BALLWIN HEALTH CARE LLC

Doing business as

Ballwin Ridge Health & Rehabilitation

Practice address

1441 Charic Dr
Ballwin, MO 63021-2001

Phone

(636) 394-2522

Fax

(636) 527-2218

NPI assigned

Sep 5, 2013

Last updated

May 16, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kam McGavock

Title

President

Phone

(410) 773-1000

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Ballwin Ridge Health & Rehabilitation Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1378339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1400198400000",
    "number": "1376978627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "920 RIDGEBROOK RD",
            "city": "SPARKS",
            "state": "MD",
            "postal_code": "211529390",
            "telephone_number": "410-773-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1441 CHARIC DR",
            "city": "BALLWIN",
            "state": "MO",
            "postal_code": "630212001",
            "telephone_number": "636-394-2522",
            "fax_number": "636-527-2218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BALLWIN HEALTH CARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-09-05",
        "last_updated": "2014-05-16",
        "status": "A",
        "authorized_official_last_name": "MCGAVOCK",
        "authorized_official_first_name": "KAM",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "410-773-1000"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103733606",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ballwin Ridge Health & Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Jay Scott Baker, M.D.
• Rebecca J Baker
• Cynthia Renee Ballentine, OTR
• Ballwin Chiropractic Center, PC
• Ballwin Family Smiles, PLLC
• Ballwin Orthopedic Group, LLC
• Alan James Banaszynski, DC
• Marissa Paulette Barbeau, PLPC
• Derrick Bark, DC, ATC
• Elaine Barnes, BCBA

• Skilled Nursing Facility in Ballwin, MO
• Providers in Ballwin, MO by specialty
• Skilled Nursing Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 16, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.