Healthcare Provider Details

I. General information

NPI: 1477616183
Provider Name (Legal Business Name): ARBOR PLACE OF CLINTON INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 04/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 PADGETT DR
CLINTON KY
42031-1313
US

IV. Provider business mailing address

1795 CLARKSON RD SUITE 200
CHESTERFIELD MO
63017-4967
US

V. Phone/Fax

Practice location:
  • Phone: 636-536-5365
  • Fax: 636-536-4533
Mailing address:
  • Phone: 636-536-5365
  • Fax: 636-536-4533

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 SELLS
Title or Position: OWNER
Credential:
Phone: 636-536-5365