Healthcare Provider Details

I. General information

NPI: 1689780330
Provider Name (Legal Business Name): NAZARETH LIVING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 NAZARETH LANE
SAINT LOUIS MO
63129-7600
US

IV. Provider business mailing address

2 NAZARETH LANE
SAINT LOUIS MO
63129-7600
US

V. Phone/Fax

Practice location:
  • Phone: 314-487-3950
  • Fax: 314-487-8001
Mailing address:
  • Phone: 314-487-3950
  • Fax: 314-487-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MS. JULIE COLLINS
Title or Position: ADMINISTRATOR
Credential:
Phone: 314-396-5686