Grand Pavilion, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

GRAND PAVILION, LLC

Doing business as

Grand Pavilion at the Plaza

Practice address

4330 Washington St
Kansas City, MO 64111-3340

Phone

(816) 753-6800

NPI assigned

Apr 2, 2019

Organization subpart

No

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

Authorized official

Name

Mr. William Matthew Novotny

Title

Manager

Phone

(785) 313-0946

Specialties & licenses 1

Addresses

Other names 1

• Grand Pavilion at the Plaza Doing business as

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

{
    "created_epoch": "1554163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1554163200000",
    "number": "1548722283",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1213 HYLTON HEIGHTS RD STE 129",
            "city": "MANHATTAN",
            "state": "KS",
            "postal_code": "665022812",
            "telephone_number": "785-313-0946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4330 WASHINGTON ST",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641113340",
            "telephone_number": "816-753-6800"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GRAND PAVILION, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-04-02",
        "last_updated": "2019-04-02",
        "status": "A",
        "authorized_official_last_name": "NOVOTNY",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "MATTHEW",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "785-313-0946",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Grand Pavilion at the Plaza",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Lauren Mackenzie Graham, LCSW
• Matthew Robert Graham, PHARMD
• Rochelle Graham, MSCCC-SLP
• Annalisa Gramlich, MS, MA
• Granby Leasing Co., LLC
• Nathan D Granger, MD
• Allegra Noel Grannell, DNP, PNP-AC/PC
• Kaitlyn Granstaff, MD
• Alexandra Grant
• Constance Kathryn Grant, L.P.C.

• Skilled Nursing Facility in Kansas City, MO
• Providers in Kansas City, 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 2, 2019; 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.