MEDICARE: ARENA MANOR, 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
1	310400000X	Assisted Living Facility	032378	MO

General Provider Information

NPI Number	:	1861549099
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ARENA MANOR, INC.

Provider Business Mailing Address
First Line	:	2614 UTAH ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-3103
Country	:	US
Telephone Number	:	313-773-3408
Fax Number	:	314-771-8699

Provider Business Practice Location Address
First Line	:	2614 UTAH ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63118-3103
Country	:	US
Telephone Number	:	313-773-3408
Fax Number	:	314-771-8699

Authorized Official
Title or Position	:	DIRECTOR OF NURSING
Name	:	MRS. JODI PATE
Credential	:	PRESIDENT
Telephone Number	:	314-773-3408

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	08/22/2020

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