Healthcare Provider Details

I. General information

NPI: 1144834367
Provider Name (Legal Business Name): TANDC OP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2020
Last Update Date: 09/04/2020
Certification Date: 09/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13995 CLAYTON RD
TOWN AND COUNTRY MO
63017-8400
US

IV. Provider business mailing address

525 CHESTNUT ST STE 102
CEDARHURST NY
11516-2223
US

V. Phone/Fax

Practice location:
  • Phone: 636-227-5070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: SAMUEL GOLDNER
Title or Position: AUTHORIZED PERSON
Credential:
Phone: 573-727-1634