Healthcare Provider Details

I. General information

NPI: 1528748324
Provider Name (Legal Business Name): ST CHARLES OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2023
Last Update Date: 07/31/2023
Certification Date: 07/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 W RANDOLPH ST
SAINT CHARLES MO
63301-0844
US

IV. Provider business mailing address

7611 STATE LINE RD STE 301
KANSAS CITY MO
64114-1698
US

V. Phone/Fax

Practice location:
  • Phone: 636-946-4966
  • Fax:
Mailing address:
  • Phone: 636-222-0060
  • Fax:

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: JOSEPH C TUTERA
Title or Position: MANAGER
Credential:
Phone: 816-444-0900