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NPI Code Detail

MEDICARE: ST CHARLES OPCO LLC

MEDICARE: ST CHARLES OPCO LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1528748324
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST CHARLES OPCO LLC
Provider Business Mailing Address
First Line : 7611 STATE LINE RD STE 301
Second Line :
City : KANSAS CITY
State : MO
Zip : 64114-1698
Country : US
Telephone Number : 636-222-0060
Fax Number :
Provider Business Practice Location Address
First Line : 2150 W RANDOLPH ST
Second Line :
City : SAINT CHARLES
State : MO
Zip : 63301-0844
Country : US
Telephone Number : 636-946-4966
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : JOSEPH C TUTERA
Credential :
Telephone Number : 816-444-0900
Provider Enumeration Date : 07/18/2023
Last Update Date : 07/31/2023

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Directions to “ST CHARLES OPCO LLC ” Practice Location

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