| NPI | 1104059559 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANTA CALDWELL Ota 314-761-8823 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: MO 2008019516) |
| Enumeration Date | 2009-09-02 |
| Last Update Date | 2009-09-02 |