Healthcare Provider Details

I. General information

NPI: 1669478665
Provider Name (Legal Business Name): WEST COUNTY CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 08/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 SOLLEY DR
BALLWIN MO
63021-5248
US

IV. Provider business mailing address

312 SOLLEY DR
BALLWIN MO
63021-5248
US

V. Phone/Fax

Practice location:
  • Phone: 636-391-0666
  • Fax: 636-391-0622
Mailing address:
  • Phone: 636-391-0666
  • Fax: 636-391-0622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number031597
License Number StateMO

VIII. Authorized Official

Name: MR. JAMES GIARDINA
Title or Position: PRESIDENT
Credential:
Phone: 636-394-3000