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NPI Code Detail

MEDICARE: PARKSIDE MEADOWS INC.

MEDICARE: PARKSIDE MEADOWS INC.
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 Facility031754MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1770579500
Entity Type Code : Organization
Provider Name (Legal Business Name) : PARKSIDE MEADOWS INC.
Provider Business Mailing 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 : 636-946-0214
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 : 636-946-0214
Authorized Official
Title or Position : VP OF FINANCE & TECHNOLOGY
Name : MR. RAY CEARNAL
Credential :
Telephone Number : 636-946-4966
Provider Enumeration Date : 09/27/2005
Last Update Date : 11/21/2011

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