Healthcare Provider Details

I. General information

NPI: 1598469199
Provider Name (Legal Business Name): CAMPBELL HEALTHCARE & SENIOR LIVING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2023
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17108 US HIGHWAY 62
CAMPBELL MO
63933-6383
US

IV. Provider business mailing address

8131 MONTICELLO AVE
SKOKIE IL
60076-3325
US

V. Phone/Fax

Practice location:
  • Phone: 573-246-2155
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: KEVIN CHANKIN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 773-945-1000