| NPI | 1831187152 |
|---|---|
| Doing Business As | FOUNTAINBLEAU LODGE |
| Entity Type | Organization |
| Authorized Contact | SHAFIQ M MALIK President 573-335-1999 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: MO 030982) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2020-08-22 |