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NPI Code Detail

MEDICARE: CPLACE ST CHARLES SNF LLC

MEDICARE: CPLACE ST CHARLES SNF 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 FacilityMO

General Provider Information

NPI Number : 1679901482
Entity Type Code : Organization
Provider Name (Legal Business Name) : CPLACE ST CHARLES SNF LLC
Provider Business Mailing Address
First Line : 310 10TH AVE N
Second Line :
City : SAFETY HARBOR
State : FL
Zip : 34695-3416
Country : US
Telephone Number : 727-797-5200
Fax Number : 727-797-3807
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 : 636-916-3386
Authorized Official
Title or Position : CFO
Name : MS. LYNDA S HEBBELN
Credential :
Telephone Number : 727-797-5200
Provider Enumeration Date : 10/15/2013
Last Update Date : 02/13/2014

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