Provider Demographics
NPI:1043093602
Name:SEYMOUR RESIDENTIAL CARE FACILITY INC.
Entity Type:Organization
Organization Name:SEYMOUR RESIDENTIAL CARE FACILITY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DORNAY
Authorized Official - Middle Name:
Authorized Official - Last Name:BURKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-456-6012
Mailing Address - Street 1:730 HODIAMONT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63112-2002
Mailing Address - Country:US
Mailing Address - Phone:314-456-6012
Mailing Address - Fax:
Practice Address - Street 1:730 HODIAMONT AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63112-2002
Practice Address - Country:US
Practice Address - Phone:314-456-6012
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility