Healthcare Provider Details

I. General information

NPI: 1710922208
Provider Name (Legal Business Name): SENIORTRUST OF COLUMBIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 TOWNE DR
COLUMBIA MO
65202-2337
US

IV. Provider business mailing address

1801 TOWNE DR
COLUMBIA MO
65202-2337
US

V. Phone/Fax

Practice location:
  • Phone: 573-474-6111
  • Fax:
Mailing address:
  • Phone: 573-474-6111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number031176
License Number StateMO

VIII. Authorized Official

Name: ROBERT WEBB
Title or Position: PRESIDENT
Credential:
Phone: 615-890-2020