Healthcare Provider Details

I. General information

NPI: 1720138027
Provider Name (Legal Business Name): ST.LUKE'S MANAGEMENT ,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 05/01/2025
Certification Date: 05/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1220 E FAIRVIEW AVE
CARTHAGE MO
64836-3122
US

IV. Provider business mailing address

1220 E FAIRVIEW AVE
CARTHAGE MO
64836-3122
US

V. Phone/Fax

Practice location:
  • Phone: 417-358-9084
  • Fax: 417-358-6991
Mailing address:
  • Phone: 417-358-9084
  • Fax: 417-358-6991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number031500
License Number StateMO

VIII. Authorized Official

Name: DEANNA SHAFFER
Title or Position: ADMINISTRATOR
Credential:
Phone: 417-358-9084