Healthcare Provider Details

I. General information

NPI: 1134124241
Provider Name (Legal Business Name): PARKLANE CARE AND REHABILITATION CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 03/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 MAR LE DR
WENTZVILLE MO
63385-1647
US

IV. Provider business mailing address

401 MAR LE DR
WENTZVILLE MO
63385-1647
US

V. Phone/Fax

Practice location:
  • Phone: 636-332-9580
  • Fax: 636-332-5633
Mailing address:
  • Phone: 636-332-9580
  • Fax: 636-332-5633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number030122
License Number StateMO

VIII. Authorized Official

Name: MS. GLYNIS WILBERT
Title or Position: ADMINISTRATOR
Credential:
Phone: 636-332-9580