Healthcare Provider Details

I. General information

NPI: 1003933607
Provider Name (Legal Business Name): MCKNIGHT PLACE EXTENDED CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2007
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 MCKNIGHT PL
SAINT LOUIS MO
63124-1900
US

IV. Provider business mailing address

2 MCKNIGHT PL
SAINT LOUIS MO
63124-1900
US

V. Phone/Fax

Practice location:
  • Phone: 314-993-2221
  • Fax: 314-372-2300
Mailing address:
  • Phone: 314-993-2221
  • Fax: 314-372-2300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number033219
License Number StateMO

VIII. Authorized Official

Name: MS. GLENDA KNITTEL
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 314-993-2221