=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912932534
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NHC HEALTHCARE-ST. CHARLES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/12/2006
-----------------------------------------------------
Last Update Date | 02/20/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 35 SUGAR MAPLE LN
-----------------------------------------------------
City | SAINT CHARLES
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63303-5740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-946-8887
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 35 SUGAR MAPLE LN
-----------------------------------------------------
City | SAINT CHARLES
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 63303-5740
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 636-946-8887
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MANAGER
-----------------------------------------------------
Name | MEL RECTOR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 636-946-3677
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 314000000X
-----------------------------------------------------
Taxonomy Name | Skilled Nursing Facility
-----------------------------------------------------
License Number | 032228
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------