Provider Demographics
NPI:1184001836
Name:CARONDELET RETIREMENT MANOR
Entity Type:Organization
Organization Name:CARONDELET RETIREMENT MANOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:VANCIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-630-3543
Mailing Address - Street 1:6811 MICHIGAN AVE.
Mailing Address - Street 2:
Mailing Address - City:ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63111
Mailing Address - Country:US
Mailing Address - Phone:314-630-3543
Mailing Address - Fax:
Practice Address - Street 1:6811 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63111-2834
Practice Address - Country:US
Practice Address - Phone:314-630-3543
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MISSOURI RESIDENTIAL CARE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-05-01
Last Update Date:2015-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO043127310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility