Healthcare Provider Details

I. General information

NPI: 1861487712
Provider Name (Legal Business Name): DELMAR GARDENS OF CHESTERFIELD OPERATING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14855 N OUTER 40 RD
CHESTERFIELD MO
63017
US

IV. Provider business mailing address

14805 N OUTER 40 RD SUITE 300
CHESTERFIELD MO
63017-6060
US

V. Phone/Fax

Practice location:
  • Phone: 636-532-0150
  • Fax: 636-532-7153
Mailing address:
  • Phone: 636-733-7000
  • Fax: 636-733-7010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number046519
License Number StateMO

VIII. Authorized Official

Name: MR. GAIL LEE HARTMANN
Title or Position: TREASURER
Credential:
Phone: 636-733-7000