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General NPI Number Information
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NPI Number | 1144834367
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Entity Type | Organization
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Legal Business Name | TANDC OP LLC
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Dates
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Enumeration Date | 09/04/2020
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Last Update Date | 09/04/2020
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Provider Practice Location Address
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Address Line | 13995 CLAYTON RD
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City | TOWN AND COUNTRY
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State | MO
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Zip | 63017-8400
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Country | US
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Telephone | 636-227-5070
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Fax |
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Provider Business Mailing Address
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Address Line | 525 CHESTNUT ST STE 102
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City | CEDARHURST
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State | NY
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Zip | 11516-2223
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | AUTHORIZED PERSON
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Name | SAMUEL GOLDNER
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Credential |
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Telephone | 573-727-1634
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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 |
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License Number State |
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