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General NPI Number Information
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NPI Number | 1588705073
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Entity Type | Organization
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Legal Business Name | MANOR GROVE, INC.
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Dates
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Enumeration Date | 02/09/2007
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Last Update Date | 08/02/2018
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Provider Practice Location Address
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Address Line | 711 S KIRKWOOD RD
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City | KIRKWOOD
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State | MO
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Zip | 63122
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Country | US
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Telephone | 314-965-0864
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Fax | 314-965-0464
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Provider Business Mailing Address
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Address Line | 711 S KIRKWOOD RD
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City | KIRKWOOD
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State | MO
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Zip | 63122-5928
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Country | US
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Telephone | 314-965-0864
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Fax | 314-965-0464
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. BARBARA D ERRICO
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Credential | MSN, LNHA
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Telephone | 314-965-0864
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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 | 031653
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License Number State | MO
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