Healthcare Provider Details

I. General information

NPI: 1093760886
Provider Name (Legal Business Name): SENIORTRUST OF CHARLEVOIX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 BOONES LICK RD
SAINT CHARLES MO
63301-2328
US

IV. Provider business mailing address

1221 BOONES LICK RD
SAINT CHARLES MO
63301-2328
US

V. Phone/Fax

Practice location:
  • Phone: 636-946-6140
  • Fax:
Mailing address:
  • Phone: 636-946-6140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number031526
License Number StateMO

VIII. Authorized Official

Name: ROBERT WEBB
Title or Position: PRESIDENT
Credential:
Phone: 615-893-2749