Provider Demographics
NPI:1205859105
Name:VILLAGE NORTH, INC.
Entity Type:Organization
Organization Name:VILLAGE NORTH, INC.
Other - Org Name:VILLAGE NORTH REHABILITATION AND NURSING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTHERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-273-0791
Mailing Address - Street 1:11133 DUNN RD
Mailing Address - Street 2:PFD 2ND FLOOR SUITE 2179
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-6119
Mailing Address - Country:US
Mailing Address - Phone:314-653-4093
Mailing Address - Fax:314-653-4077
Practice Address - Street 1:11160 VILLAGE NORTH DR
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-6159
Practice Address - Country:US
Practice Address - Phone:314-355-8010
Practice Address - Fax:314-653-4801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-25
Last Update Date:2021-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO030933314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
36044OtherGHP
MO101863405Medicaid
138311OtherHEALTH LINK
195321OtherBLUE CROSS BLUE SHIELD
7101115OtherUNITED HEALTHCARE
=========OtherGREAT WEST HEALTHCARE
MO101863405Medicaid
195321OtherBLUE CROSS BLUE SHIELD
36044OtherGHP
138311OtherHEALTH LINK
7101115OtherUNITED HEALTHCARE
195321OtherBLUE CROSS BLUE SHIELD