Provider Demographics
NPI:1386635910
Name:FRIENDSHIP VILLAGE OF WEST COUNTY
Entity Type:Organization
Organization Name:FRIENDSHIP VILLAGE OF WEST COUNTY
Other - Org Name:FRIENDSHIP VILLAGE CHESTERFIELD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMPION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-270-7810
Mailing Address - Street 1:15250 VILLAGE VIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-1810
Mailing Address - Country:US
Mailing Address - Phone:636-532-1515
Mailing Address - Fax:636-733-0139
Practice Address - Street 1:15250 VILLAGE VIEW DRIVE
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-1810
Practice Address - Country:US
Practice Address - Phone:636-532-1515
Practice Address - Fax:636-733-0139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-02
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031648314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101486603Medicaid
MO031648OtherSTATE LICENSE
MO031648OtherSTATE LICENSE