Healthcare Provider Details

I. General information

NPI: 1720172869
Provider Name (Legal Business Name): LUTHERAN SENIOR SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 09/20/2023
Certification Date: 09/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 BREEZE PARK DR
WELDON SPRING MO
63304-9142
US

IV. Provider business mailing address

1150 HANLEY INDUSTRIAL CT
SAINT LOUIS MO
63144-1910
US

V. Phone/Fax

Practice location:
  • Phone: 636-939-5223
  • Fax: 636-939-5865
Mailing address:
  • Phone: 314-968-9313
  • Fax: 314-968-5590

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number032551
License Number StateMO

VIII. Authorized Official

Name: CHADWICK SNEED
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 314-446-2405