MEDICARE: WOODLAND MANOR OF ARNOLD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245391507
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WOODLAND MANOR OF ARNOLD LLC

Provider Business Mailing Address
First Line	:	1749 GILSINN LN
Second Line	:
City	:	FENTON
State	:	MO
Zip	:	63026-2003
Country	:	US
Telephone Number	:	636-349-2311
Fax Number	:	636-349-6491

Provider Business Practice Location Address
First Line	:	100 WOODLAND MNR
Second Line	:
City	:	ARNOLD
State	:	MO
Zip	:	63010-2030
Country	:	US
Telephone Number	:	636-296-1400
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	GREG SPENCE
Credential	:
Telephone Number	:	636-349-2311

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	06/11/2014

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