Provider Demographics
NPI:1417931635
Name:RILEY SPENCE PROPERTIES NO. 2 LLC
Entity Type:Organization
Organization Name:RILEY SPENCE PROPERTIES NO. 2 LLC
Other - Org Name:THE WOODLANDS OF MARYLAND HEIGHTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:J
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:I
Authorized Official - Credentials:
Authorized Official - Phone:636-349-2311
Mailing Address - Street 1:1749 GILSINN LN
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-2003
Mailing Address - Country:US
Mailing Address - Phone:636-349-2311
Mailing Address - Fax:636-349-6491
Practice Address - Street 1:3201 PARKWOOD LN
Practice Address - Street 2:
Practice Address - City:MARYLAND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63043-1334
Practice Address - Country:US
Practice Address - Phone:314-291-5911
Practice Address - Fax:314-291-3576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031509314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
265523Medicare ID - Type Unspecified