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General NPI Number Information
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NPI Number | 1386635910
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Entity Type | Organization
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Legal Business Name | FRIENDSHIP VILLAGE OF WEST COUNTY
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Dates
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Enumeration Date | 11/02/2005
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Last Update Date | 10/01/2020
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Provider Practice Location Address
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Address Line | 15250 VILLAGE VIEW DRIVE
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City | CHESTERFIELD
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State | MO
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Zip | 63017-1810
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Country | US
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Telephone | 636-532-1515
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Fax | 636-733-0139
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Provider Business Mailing Address
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Address Line | 15250 VILLAGE VIEW DRIVE
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City | CHESTERFIELD
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State | MO
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Zip | 63017-1810
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Country | US
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Telephone | 636-532-1515
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Fax | 636-733-0139
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Authorized Official
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Title or Position | OFFICER
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Name | SUE CHAMPION
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Credential |
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Telephone | 314-270-7810
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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 | 031648
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License Number State | MO
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