Provider Demographics
NPI:1003933607
Name:MCKNIGHT PLACE EXTENDED CARE LLC
Entity Type:Organization
Organization Name:MCKNIGHT PLACE EXTENDED CARE LLC
Other - Org Name:MCKNIGHT PLACE EXTENDED CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KNITTEL
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:314-993-2221
Mailing Address - Street 1:2 MCKNIGHT PL
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-1900
Mailing Address - Country:US
Mailing Address - Phone:314-993-2221
Mailing Address - Fax:314-372-2300
Practice Address - Street 1:2 MCKNIGHT PL
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-1900
Practice Address - Country:US
Practice Address - Phone:314-993-2221
Practice Address - Fax:314-372-2300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-26
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO033219314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO033219OtherSNF LICENSE NO.
MO107809204OtherPROVIDER NUMBER
MO18914AOtherFACILITY NUMBER