GARDEN VILLAS NORTH
NPI 1497164834
Assisted Living Facility in Black Jack, MO

NPI Status: Active since August 11, 2014

Contact Information

4505 PARKER RD
BLACK JACK, MO
ZIP 63033
Phone: (314) 355-6100
Fax: (314) 355-1463

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  • Organization
  • Assisted Living Facility
  • CLIA Number: 26D2071712
  • CLIA Cert. Type: Assisted Living Facility
  • CLIA Exp. Date: 01-16-2026

About GARDEN VILLAS NORTH

This page provides the complete NPI Profile along with additional information for Garden Villas North, a provider established in Black Jack, Missouri operating as a Assisted Living Facility. The healthcare provider is registered in the NPI registry with number 1497164834 assigned on August 2014. The practitioner's primary taxonomy code is 310400000X with license number 041853 (MO). The provider is registered as an organization and their NPI record was last updated 11 years ago. The provider's is doing business as Garden Villas North. The authorized official of this NPI record is Mr. Gail Lee Hartmann (Treasurer)

NPI
1497164834
Provider Legal Name
GARDEN VILLAS NORTH, LLC
Other Organization Name
GARDEN VILLAS NORTH
Other Name Type
Doing Business As (3)
Entity Type
Organization
Location Address
4505 PARKER RD BLACK JACK, MO 63033
Location Phone
(314) 355-6100
Location Fax
(314) 355-1463
Mailing Address
14805 N OUTER 40 RD SUITE 300 CHESTERFIELD, MO 63017
Mailing Phone
(636) 733-7000
Mailing Fax
(314) 355-1463
Is Sole Proprietor?
No
Is Organization Subpart?
No
Enumeration Date
08-11-2014
Last Update Date
08-11-2014
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Specialty - Primary Taxonomy

The NPI enumerator requires providers to submit at least one taxonomy code. A taxonomy code is a unique 10-character code that describes the healthcare provider type, classification, and the area of specialization. There could be only one primary taxonomy code per NPI record. For individual NPIs the license data is associated to the taxonomy code.

Classification

Assisted Living Facility

Taxonomy Code
310400000X
Type
Nursing & Custodial Care Facilities
License No.
041853
License State
MO
Taxonomy Description
A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being.

Authorized Official

The authorized official is the designated individual with the legal authority to make changes to the provider’s official NPI record. For organizations, the authorized official must be a general partner, chairman of the board, CEO, CFO or a direct owner holding at least a 5 percent stake in the medical organization.

Authorized Official Name

MR. GAIL LEE HARTMANN

Authorized Official Title
TREASURER
Authorized Official Phone
(636) 733-7000

CLIA Information

The Clinical Laboratory Improvement Amendments (CLIA) of 1988 applies to facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease. The CLIA Program sets standards for clinical laboratory testing and issues certificates. The NPI / CLIA crosswalk information for this NPI number is:

CLIA Number
26D2071712
Facility Type
Assisted Living Facility
Certificate Effective Date
January 17, 2024
Certificate Expiration Date
January 16, 2026
Laboratory Director
BABU DANDAMUDI
Certificate Type
Certificate of Waiver
Certificate Type Description
This CLIA certificate is issued to Garden Villas North to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria.

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NPI Validation Check Digit Calculation


The following table explains the step by step NPI number validation process using the ISO standard Luhn algorithm.

Start with the original NPI number, the last digit is the check digit and is not used in the calculation.
1497164834
Step 1: Double the value of the alternate digits, beginning with the rightmost digit.
2418726886
Step 2: Add all the doubled and unaffected individual digits from step 1 plus the constant number 24.
2 + 4 + 1 + 8 + 7 + 2 + 6 + 8 + 8 + 6 + 24 = 76
Step 3: Subtract the total obtained in step 2 from the next higher number ending in zero, the result is the check digit.
80 - 76 = 44

The NPI number 1497164834 is valid because the calculated check digit 4 using the Luhn validation algorithm matches the last digit of the original NPI number.

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1497164834, enumerated in the NPI registry as an "organization" on August 11, 2014

The provider is located at 4505 Parker Rd Black Jack, Mo 63033 and the phone number is (314) 355-6100

This medical organization specializes in Assisted Living Facility with taxonomy code 310400000X

The provider's CLIA number is 26D2071712 for a "assisted living facility" facility with a CLIA Certificate of Waiver. This CLIA certificate is issued to perform only waived tests. CLIA defines waived tests as simple tests with a low risk for an incorrect result. Waived tests include certain tests listed in CLIA regulations, tests cleared by the FDA for home use and tests approved by the FDA for waived status and that meet CLIA waiver criteria..

This NPI record was last updated on August 11, 2014. To officially update your NPI information contact the National Plan and Provider Enumeration System (NPPES) at 1-800-465-3203 (NPI Toll-Free) or by email at [email protected].
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