Healthcare Provider Details

I. General information

NPI: 1205996634
Provider Name (Legal Business Name): GARDEN VIEW CARE CENTER OF ST. LOUIS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 06/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13612 BIG BEND RD
VALLEY PARK MO
63088-1447
US

IV. Provider business mailing address

13612 BIG BEND RD
VALLEY PARK MO
63088-1447
US

V. Phone/Fax

Practice location:
  • Phone: 636-861-0500
  • Fax: 636-861-3414
Mailing address:
  • Phone: 636-861-0500
  • Fax: 636-861-3414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number033296
License Number StateMO

VIII. Authorized Official

Name: MR. MICHAEL C. SCHRAPPEN
Title or Position: ADMINISTRATOR
Credential: NHA
Phone: 636-861-0500