Provider Demographics
NPI:1972694271
Name:RAYMORE CARE CENTER LLC
Entity type:Organization
Organization Name:RAYMORE CARE CENTER LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MELVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:DUNSWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-322-1991
Mailing Address - Street 1:600 E SUNRISE DR
Mailing Address - Street 2:
Mailing Address - City:RAYMORE
Mailing Address - State:MO
Mailing Address - Zip Code:64083-9037
Mailing Address - Country:US
Mailing Address - Phone:816-322-1991
Mailing Address - Fax:816-322-4810
Practice Address - Street 1:600 E SUNRISE DR
Practice Address - Street 2:
Practice Address - City:RAYMORE
Practice Address - State:MO
Practice Address - Zip Code:64083-9037
Practice Address - Country:US
Practice Address - Phone:816-322-1991
Practice Address - Fax:816-322-4810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031724310400000X
MO032153314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Not Answered314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO90462017OtherBC/BS PROVIDER NUMBER
MO90462017OtherBC/BS PROVIDER NUMBER