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General NPI Number Information
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NPI Number | 1598009185
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Entity Type | Organization
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Legal Business Name | VILLAGE CENTER CARE OF WENTZVILLE LLC
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Dates
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Enumeration Date | 11/20/2012
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Last Update Date | 11/20/2012
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Provider Practice Location Address
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Address Line | 909 E PITMAN AVE
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City | WENTZVILLE
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State | MO
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Zip | 63385-1818
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Country | US
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Telephone | 636-327-1907
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Fax |
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Provider Business Mailing Address
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Address Line | 909 E PITMAN AVE
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City | WENTZVILLE
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State | MO
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Zip | 63385-1818
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Country | US
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Telephone | 636-327-1907
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. JENNIFER ELLEN GETTMAN
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Credential | MA GERENTOLOGY, NHA
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Telephone | 636-219-3114
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 040664
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License Number State | MO
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