Healthcare Provider Details

I. General information

NPI: 1750759270
Provider Name (Legal Business Name): WINDSOR ESTATES OF ST CHARLES SNAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2015
Last Update Date: 04/23/2021
Certification Date: 04/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2150 W RANDOPLPH ST
ST CHARLES MO
63301-8738
US

IV. Provider business mailing address

2150 W RANDOLPH ST
SAINT CHARLES MO
63301-0844
US

V. Phone/Fax

Practice location:
  • Phone: 636-946-4966
  • Fax:
Mailing address:
  • Phone: 636-946-4966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: HELEN LACEK
Title or Position: COO
Credential:
Phone: 708-670-4737