Provider Demographics
NPI:1265635742
Name:ST. CLEMENTS HEALTHCARE CENTER
Entity Type:Organization
Organization Name:ST. CLEMENTS HEALTHCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:BR THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-464-3666
Mailing Address - Street 1:300 LIGUORI DR
Mailing Address - Street 2:
Mailing Address - City:LIGUORI
Mailing Address - State:MO
Mailing Address - Zip Code:63057-9997
Mailing Address - Country:US
Mailing Address - Phone:636-464-3666
Mailing Address - Fax:636-464-4717
Practice Address - Street 1:300 LIGUORI DR
Practice Address - Street 2:
Practice Address - City:LIGUORI
Practice Address - State:MO
Practice Address - Zip Code:63057-9997
Practice Address - Country:US
Practice Address - Phone:636-464-3666
Practice Address - Fax:636-464-4717
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2007-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility