Provider Demographics
NPI:1225464001
Name:SPRING MANOR LLC
Entity Type:Organization
Organization Name:SPRING MANOR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SALEH
Authorized Official - Middle Name:
Authorized Official - Last Name:MALIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-265-6634
Mailing Address - Street 1:2931 N SPRING AVE
Mailing Address - Street 2:APT/SUITE
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63107-2306
Mailing Address - Country:US
Mailing Address - Phone:314-533-3111
Mailing Address - Fax:314-533-3120
Practice Address - Street 1:3610 PALM ST.
Practice Address - Street 2:APT/SUITE
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63107
Practice Address - Country:US
Practice Address - Phone:314-533-3111
Practice Address - Fax:314-533-3120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-24
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0412083104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness