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General NPI Number Information
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NPI Number | 1265635742
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Entity Type | Organization
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Legal Business Name | ST. CLEMENTS HEALTHCARE CENTER
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 08/01/2007
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Provider Practice Location Address
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Address Line | 300 LIGUORI DR
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City | LIGUORI
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State | MO
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Zip | 63057-9997
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Country | US
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Telephone | 636-464-3666
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Fax | 636-464-4717
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Provider Business Mailing Address
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Address Line | 300 LIGUORI DR
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City | LIGUORI
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State | MO
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Zip | 63057-9997
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Country | US
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Telephone | 636-464-3666
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Fax | 636-464-4717
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | BR THOMAS WRIGHT
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Credential |
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Telephone | 636-464-3666
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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 | MO
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