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General NPI Number Information
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NPI Number | 1093760886
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Entity Type | Organization
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Legal Business Name | SENIORTRUST OF CHARLEVOIX, LLC
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Dates
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Enumeration Date | 05/23/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1221 BOONES LICK RD
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City | SAINT CHARLES
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State | MO
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Zip | 63301-2328
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Country | US
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Telephone | 636-946-6140
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Fax |
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Provider Business Mailing Address
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Address Line | 1221 BOONES LICK RD
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City | SAINT CHARLES
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State | MO
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Zip | 63301-2328
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Country | US
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Telephone | 636-946-6140
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERT WEBB
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Credential |
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Telephone | 615-893-2749
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 031526
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License Number State | MO
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