Healthcare Provider Details

I. General information

NPI: 1700242377
Provider Name (Legal Business Name): DES PERES HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2016
Last Update Date: 03/22/2016
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

13230 MANCHESTER RD
DES PERES MO
63131-1706
US

V. Phone/Fax

Practice location:
  • Phone: 314-821-2886
  • Fax: 314-821-7511
Mailing address:
  • Phone: 314-821-2886
  • Fax: 314-821-7511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DOV WINTER
Title or Position: CEO
Credential:
Phone: 314-631-3000