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General NPI Number Information
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NPI Number | 1063730869
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Entity Type | Organization
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Legal Business Name | JOHN ROBERT REITER RESIDENTIAL CARE
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Dates
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Enumeration Date | 05/04/2010
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Last Update Date | 05/04/2010
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Provider Practice Location Address
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Address Line | 5415 THEKLA AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63120-2513
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Country | US
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Telephone | 314-385-8180
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Fax | 314-385-8880
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Provider Business Mailing Address
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Address Line | 5415 THEKLA AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63120-2513
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Country | US
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Telephone | 314-385-8180
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Fax | 314-385-8880
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. KAREN MICHELLE REITER
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Credential |
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Telephone | 314-497-6331
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 037959
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License Number State | MO
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