Healthcare Provider Details

I. General information

NPI: 1518857713
Provider Name (Legal Business Name): ANNIES GARDEN SKILLED NURSING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2025
Last Update Date: 12/15/2025
Certification Date: 12/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 STALLCUP DR
SIKESTON MO
63801-9387
US

IV. Provider business mailing address

302 STALLCUP DR
SIKESTON MO
63801-9387
US

V. Phone/Fax

Practice location:
  • Phone: 573-621-4910
  • Fax: 573-258-9823
Mailing address:
  • Phone: 573-621-4910
  • Fax: 573-258-9823

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: MR. BENJAMIN P SELLS
Title or Position: CEO
Credential:
Phone: 573-614-7472