Healthcare Provider Details

I. General information

NPI: 1932345907
Provider Name (Legal Business Name): BKY HEALTHCARE OF MILAN, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2008
Last Update Date: 05/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

52435 INFIRMARY ROAD
MILAN MO
63556-2874
US

IV. Provider business mailing address

1869 CRAIG PARK CT
SAINT LOUIS MO
63146-4122
US

V. Phone/Fax

Practice location:
  • Phone: 660-265-4032
  • Fax: 660-265-4562
Mailing address:
  • Phone: 314-543-3800
  • Fax: 314-543-3880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number036462
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number038697
License Number StateMO

VIII. Authorized Official

Name: MR. ASHWIN DUNDOO
Title or Position: FINANCE
Credential:
Phone: 314-543-3800