Healthcare Provider Details

I. General information

NPI: 1730568874
Provider Name (Legal Business Name): CHEROKEE RESIDENTIAL CARE ACQUISITION, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2015
Last Update Date: 05/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3409 MISSOURI AVE
SAINT LOUIS MO
63118-3236
US

IV. Provider business mailing address

1093 HAWKINS BEND DR
FENTON MO
63026-7229
US

V. Phone/Fax

Practice location:
  • Phone: 314-771-8360
  • Fax: 314-771-1377
Mailing address:
  • Phone: 314-277-3851
  • Fax: 314-771-1377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: JOANN PATE
Title or Position: PRESIDENT
Credential:
Phone: 314-277-3851