Provider Demographics
NPI:1245605211
Name:KING CITY HEALTHCARE, LLC
Entity Type:Organization
Organization Name:KING CITY HEALTHCARE, LLC
Other - Org Name:KING CITY MANOR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JUDAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BIENSTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-631-3000
Mailing Address - Street 1:6 CITYPLACE DR
Mailing Address - Street 2:SUITE 430
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-7157
Mailing Address - Country:US
Mailing Address - Phone:314-631-3000
Mailing Address - Fax:314-942-6634
Practice Address - Street 1:300 W FAIRVIEW ST
Practice Address - Street 2:
Practice Address - City:KING CITY
Practice Address - State:MO
Practice Address - Zip Code:64463-9606
Practice Address - Country:US
Practice Address - Phone:660-535-4325
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-02
Last Update Date:2015-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility