Healthcare Provider Details

I. General information

NPI: 1235127069
Provider Name (Legal Business Name): CHARITON PARK HEALTH CARE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 04/04/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

902 MANOR DR
SALISBURY MO
65281-1236
US

IV. Provider business mailing address

1869 CRAIG PARK CT
SAINT LOUIS MO
63146-4122
US

V. Phone/Fax

Practice location:
  • Phone: 660-388-6486
  • Fax:
Mailing address:
  • Phone: 314-543-3800
  • Fax: 314-543-3880

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: ASHWIN DUNDOO
Title or Position: FINANCE
Credential:
Phone: 314-543-3800