Carondelet Long Term Care Facilities, Inc.

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

031289 Issued in MO

Legal business name

CARONDELET LONG TERM CARE FACILITIES, INC.

Doing business as

St. Mary's Manor

Practice address

111 NW Mock Ave
Blue Springs, MO 64014-2503

Phone

(816) 228-5655

Fax

(816) 228-8480

NPI assigned

Aug 16, 2005

Organization subpart

No

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

Authorized official

Name

Mr. Anthony Columbatto

Title

Administrator, Ceo

Phone

(816) 228-5655

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• St. Mary's Manor Doing business as

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

{
    "created_epoch": "1124150400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1414368000000",
    "number": "1710979836",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "111 NW MOCK AVE",
            "city": "BLUE SPRINGS",
            "state": "MO",
            "postal_code": "640142503",
            "telephone_number": "816-228-5655",
            "fax_number": "816-228-8480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "111 NW MOCK AVE",
            "city": "BLUE SPRINGS",
            "state": "MO",
            "postal_code": "640142503",
            "telephone_number": "816-228-5655",
            "fax_number": "816-228-8480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CARONDELET LONG TERM CARE FACILITIES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-08-16",
        "last_updated": "2014-10-27",
        "status": "A",
        "authorized_official_last_name": "COLUMBATTO",
        "authorized_official_first_name": "ANTHONY",
        "authorized_official_title_or_position": "ADMINISTRATOR, CEO",
        "authorized_official_telephone_number": "816-228-5655",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "031289",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102390309",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "St. Mary's Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Jaime Ann Carlson, OTR/L
• Jayde Carlson
• Sarah Carollo, BCBA
• Carondelet Physician Services Inc
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• Carondelet Physician Services, Inc.
• Jamie Lyn Carver, LCSW

• Skilled Nursing Facility in Blue Springs, MO
• Providers in Blue Springs, 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 Oct 27, 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.