Healthcare Provider Details

I. General information

NPI: 1588079271
Provider Name (Legal Business Name): DIVERSICARE OF CHATEAU LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2014
Last Update Date: 11/07/2022
Certification Date: 11/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

811 N 9TH ST
SAINT JOSEPH MO
64501-1651
US

IV. Provider business mailing address

811 N 9TH ST
SAINT JOSEPH MO
64501-1651
US

V. Phone/Fax

Practice location:
  • Phone: 816-233-5164
  • Fax: 816-233-5211
Mailing address:
  • Phone: 816-233-5164
  • Fax: 816-233-5211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number042612
License Number StateMO

VIII. Authorized Official

Name: MATTHEW J WEISHAAR
Title or Position: CFO AND SECRETARY
Credential:
Phone: 615-771-7575