Provider Demographics
NPI:1487348389
Name:WILDFLOWER RIVERHOUSE LLC
Entity type:Organization
Organization Name:WILDFLOWER RIVERHOUSE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:E
Authorized Official - Last Name:GAUME
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-248-2144
Mailing Address - Street 1:3831 FREDERICK AVE # 106
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64506-3020
Mailing Address - Country:US
Mailing Address - Phone:816-248-2144
Mailing Address - Fax:
Practice Address - Street 1:1415 OLIVE ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64503-2443
Practice Address - Country:US
Practice Address - Phone:816-273-5070
Practice Address - Fax:816-273-5070
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WILDFLOWER RIVERHOUSE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-05
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)Group - Single Specialty