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General NPI Number Information
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NPI Number | 1861487712
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Entity Type | Organization
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Legal Business Name | DELMAR GARDENS OF CHESTERFIELD OPERATING, LLC
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Dates
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Enumeration Date | 09/16/2005
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Last Update Date | 08/13/2018
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Provider Practice Location Address
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Address Line | 14855 N OUTER 40 RD
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City | CHESTERFIELD
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State | MO
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Zip | 63017
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Country | US
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Telephone | 636-532-0150
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Fax | 636-532-7153
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Provider Business Mailing Address
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Address Line | 14805 N OUTER 40 RD SUITE 300
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City | CHESTERFIELD
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State | MO
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Zip | 63017-6060
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Country | US
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Telephone | 636-733-7000
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Fax | 636-733-7010
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Authorized Official
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Title or Position | TREASURER
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Name | MR. GAIL LEE HARTMANN
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Credential |
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Telephone | 636-733-7000
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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 | 046519
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License Number State | MO
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