SRZ Op Ballwin LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

SRZ OP BALLWIN LLC

Doing business as

Ballwin Ridge Health & Rehabilitation

Practice address

1441 Charic Dr
Wildwood, MO 63021

Phone

(636) 394-2522

NPI assigned

May 17, 2018

Last updated

May 17, 2018By the provider in NPPES

Organization subpart

Yes

Parent organization

SRZ OP HOLDINGS LLCAs reported in NPPES

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

Authorized official

Name

Samuel Goldner

Title

Authorized Person/Official

Phone

(347) 677-0448

Specialties & licenses 1

Addresses

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": "1526515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1526515200000",
    "number": "1740770494",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 HERRICK DR",
            "city": "LAWRENCE",
            "state": "NY",
            "postal_code": "115591528",
            "telephone_number": "929-928-0307"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1441 CHARIC DR",
            "city": "WILDWOOD",
            "state": "MO",
            "postal_code": "63021",
            "telephone_number": "636-394-2522"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SRZ OP BALLWIN LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SRZ OP HOLDINGS LLC",
        "enumeration_date": "2018-05-17",
        "last_updated": "2018-05-17",
        "status": "A",
        "authorized_official_last_name": "GOLDNER",
        "authorized_official_first_name": "SAMUEL",
        "authorized_official_title_or_position": "AUTHORIZED PERSON/OFFICIAL",
        "authorized_official_telephone_number": "347-677-0448"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ballwin Ridge Health & Rehabilitation",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Kyle Sherwood
• James Wesley Sites, CRNFA
• E Denise Smith, MA, PLPC
• Holly Smith, BCABA
• Susan Snyders, MA
• Gregory S St. John, DDS
• Thomas J. Stauder, MD
• Michelle Steeg, MA, PLPC
• Peggy Stiffler, RNFA
• Sunlight Psychiatry and Wellness, LLC

• Skilled Nursing Facility in Wildwood, MO
• Providers in Wildwood, 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 17, 2018; 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.