Healthcare Provider Details

I. General information

NPI: 1003224825
Provider Name (Legal Business Name): SILVERSTONE SNF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 03/16/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2735 EAGLESON DR
ROLLA MO
65401-8384
US

IV. Provider business mailing address

2735 EAGLESON DR.
ROLLA MO
65401-8384
US

V. Phone/Fax

Practice location:
  • Phone: 573-426-6200
  • Fax: 573-426-6050
Mailing address:
  • Phone: 573-426-6200
  • Fax: 573-426-6050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier100021124
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer

VIII. Authorized Official

Name: GREG SPENCE
Title or Position: MEMBER
Credential:
Phone: 636-349-2311