Healthcare Provider Details

I. General information

NPI: 1346716339
Provider Name (Legal Business Name): ST. JOSEPH SENIOR LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2018
Last Update Date: 10/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 N 36TH ST
SAINT JOSEPH MO
64506-2359
US

IV. Provider business mailing address

3225 EMERALD LN STE B
JEFFERSON CITY MO
65109-6869
US

V. Phone/Fax

Practice location:
  • Phone: 816-676-1630
  • Fax: 816-232-5862
Mailing address:
  • Phone: 573-556-6240
  • Fax: 573-556-6241

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: BENJAMIN SCHEULEN
Title or Position: CHIEF OPERATING OFFICER
Credential:
Phone: 573-556-6240