Healthcare Provider Details

I. General information

NPI: 1184001836
Provider Name (Legal Business Name): CARONDELET RETIREMENT MANOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2015
Last Update Date: 05/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6811 MICHIGAN AVE
SAINT LOUIS MO
63111-2834
US

IV. Provider business mailing address

6811 MICHIGAN AVE.
ST LOUIS MO
63111
US

V. Phone/Fax

Practice location:
  • Phone: 314-630-3543
  • Fax:
Mailing address:
  • Phone: 314-630-3543
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number043127
License Number StateMO

VIII. Authorized Official

Name: CHRISTOPHER MICHAEL VANCIL
Title or Position: OWNER
Credential:
Phone: 314-630-3543