Healthcare Provider Details

I. General information

NPI: 1366570079
Provider Name (Legal Business Name): ST. JOHNS PLACE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BROWN RD
SAINT LOUIS MO
63114-4327
US

IV. Provider business mailing address

3333 BROWN RD
SAINT LOUIS MO
63114-4327
US

V. Phone/Fax

Practice location:
  • Phone: 314-426-2211
  • Fax: 314-890-2280
Mailing address:
  • Phone: 314-426-2211
  • Fax: 314-890-2280

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number033727
License Number StateMO

VIII. Authorized Official

Name: MR. DAVID J BENTLEY
Title or Position: ADMINISTRATOR OWNER
Credential:
Phone: 314-426-2211