Healthcare Provider Details

I. General information

NPI: 1508910118
Provider Name (Legal Business Name): CATHEDRAL ROCK OF NORTH ST LOUIS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 04/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 REDMAN RD
SAINT LOUIS MO
63136-5863
US

IV. Provider business mailing address

306 W 7TH ST STE 415
FORT WORTH TX
76102-4905
US

V. Phone/Fax

Practice location:
  • Phone: 314-355-8585
  • Fax: 314-355-4645
Mailing address:
  • Phone: 817-335-4111
  • Fax: 817-335-0800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number031953
License Number StateMO

VIII. Authorized Official

Name: CHARLES KENT HARRINGTON
Title or Position: PRESIDENT
Credential:
Phone: 817-335-4111