Buckeye J, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

031659 Issued in MO

Legal business name

BUCKEYE J, LLC

Doing business as

Jackson Manor Nursing Home

Practice address

710 Broadridge Dr
Jackson, MO 63755-3042

Phone

(573) 243-3101

Fax

(573) 243-6742

NPI assigned

Nov 1, 2005

Last updated

Apr 25, 2016By 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

Jay Moskowitz

Title

President

Phone

(303) 238-3838

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Jackson Manor Nursing Home Doing business as

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

{
    "created_epoch": "1130803200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1461542400000",
    "number": "1457342289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12136 W BAYAUD AVE",
            "address_2": "SUITE 200",
            "city": "LAKEWOOD",
            "state": "CO",
            "postal_code": "802282115",
            "telephone_number": "303-238-3838",
            "fax_number": "303-987-0434"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "710 BROADRIDGE DR",
            "city": "JACKSON",
            "state": "MO",
            "postal_code": "637553042",
            "telephone_number": "573-243-3101",
            "fax_number": "573-243-6742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BUCKEYE J, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-11-01",
        "last_updated": "2016-04-25",
        "status": "A",
        "authorized_official_last_name": "MOSKOWITZ",
        "authorized_official_first_name": "JAY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "303-238-3838"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "031659",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101456606",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Jackson Manor Nursing Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Amy Elizabeth Brueckner, M.A.,CCC-SLP
• Chelsea Ann Bucher, FNP
• Lacy Bucher
• Deanna Maria Buchheit, MA, CCC-SLP
• Laura Lee Buchheit, LPC
• Benjamin Scott Buescher, PHARMD
• Mary Linda Byndom, FNP
• Jonnie Callahan
• Andrew Callis
• Laurie Elizabeth Carlton, RD

• Skilled Nursing Facility in Jackson, MO
• Providers in Jackson, 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 Apr 25, 2016; 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.