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General NPI Number Information
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NPI Number | 1942618319
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Entity Type | Organization
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Legal Business Name | CHAPEL RIDGE ASSISTED LIVING
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Dates
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Enumeration Date | 07/29/2014
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Last Update Date | 07/29/2014
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Provider Practice Location Address
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Address Line | 10160 RESTORATION CIRCLE
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City | MINERAL POINT
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State | MO
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Zip | 63660
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Country | US
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Telephone | 573-562-0303
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Fax | 573-562-7743
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Provider Business Mailing Address
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Address Line | PO BOX 534
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City | PARK HILLS
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State | MO
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Zip | 63601-0534
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Country | US
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Telephone | 573-562-0303
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Fax | 573-562-7743
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Authorized Official
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Title or Position | BUSINESS ADMINISTRATOR
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Name | RANDY GLEN MCDONALD
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Credential |
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Telephone | 573-562-0303
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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 | 042272
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License Number State | MO
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