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General NPI Number Information
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NPI Number | 1205859105
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Entity Type | Organization
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Legal Business Name | VILLAGE NORTH, INC.
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Dates
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Enumeration Date | 07/25/2006
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Last Update Date | 03/23/2021
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Provider Practice Location Address
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Address Line | 11160 VILLAGE NORTH DR
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City | SAINT LOUIS
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State | MO
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Zip | 63136-6159
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Country | US
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Telephone | 314-355-8010
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Fax | 314-653-4801
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Provider Business Mailing Address
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Address Line | 11133 DUNN RD PFD 2ND FLOOR SUITE 2179
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City | SAINT LOUIS
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State | MO
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Zip | 63136-6119
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Country | US
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Telephone | 314-653-4093
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Fax | 314-653-4077
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Authorized Official
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Title or Position | OFFICER
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Name | MR. DANIEL ROTHERY
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Credential |
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Telephone | 314-273-0791
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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 | 030933
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License Number State | MO
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