Healthcare Provider Details

I. General information

NPI: 1457456667
Provider Name (Legal Business Name): ST. PETERS MANOR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

230 SPENCER RD
SAINT PETERS MO
63376-2425
US

IV. Provider business mailing address

230 SPENCER ROAD
ST PETERS MO
63376
US

V. Phone/Fax

Practice location:
  • Phone: 636-441-2750
  • Fax: 636-447-2835
Mailing address:
  • Phone: 636-441-2750
  • Fax: 636-447-2835

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number019803SNF
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number0168041CF
License Number StateMO

VIII. Authorized Official

Name: BENJAMIN C. SCHEULEN
Title or Position: CEO
Credential:
Phone: 573-556-6240