Healthcare Provider Details

I. General information

NPI: 1497089643
Provider Name (Legal Business Name): DES PERES OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2009
Last Update Date: 03/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13230 MANCHESTER RD
DES PERES MO
63131-1706
US

IV. Provider business mailing address

1500 WATERS RIDGE DR
LEWISVILLE TX
75057-6011
US

V. Phone/Fax

Practice location:
  • Phone: 314-821-2886
  • Fax:
Mailing address:
  • Phone: 972-899-4401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateMO

VIII. Authorized Official

Name: PAULA PIERCE
Title or Position: AUTHORIZED OFFICER
Credential:
Phone: 972-899-4401