Healthcare Provider Details

I. General information

NPI: 1104800101
Provider Name (Legal Business Name): ARBOR PLACE OF CLINTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 PADGETT DRIVE
CLINTON KY
42031
US

IV. Provider business mailing address

258 NORTH KINGSHIGHWAY
SIKESTON MO
63801
US

V. Phone/Fax

Practice location:
  • Phone: 270-653-5558
  • Fax: 270-653-5522
Mailing address:
  • Phone: 573-471-5800
  • Fax: 573-471-6649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number100181
License Number StateKY

VIII. Authorized Official

Name: MR. JOHN M. SELLS
Title or Position: PRESIDENT/CEO
Credential:
Phone: 573-471-5800