Healthcare Provider Details

I. General information

NPI: 1013305127
Provider Name (Legal Business Name): ELDERCARE OF MID-MISSOURI XIII INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2014
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 WEIN ST
HERMANN MO
65041-1601
US

IV. Provider business mailing address

2500 S OLD HIGHWAY 94 SUITE 104
SAINT CHARLES MO
63303-5616
US

V. Phone/Fax

Practice location:
  • Phone: 636-477-3280
  • Fax: 636-477-3241
Mailing address:
  • Phone: 636-477-3280
  • Fax: 636-477-3241

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: DEANNA BOKEL
Title or Position: OWNER
Credential:
Phone: 636-477-3280