Provider Demographics
NPI:1437897543
Name:SUPERIOR MANOR OF FESTUS LLC
Entity Type:Organization
Organization Name:SUPERIOR MANOR OF FESTUS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:WINBUSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-624-5575
Mailing Address - Street 1:231 S BEMISTON AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63105-1988
Mailing Address - Country:US
Mailing Address - Phone:314-624-5575
Mailing Address - Fax:314-921-2642
Practice Address - Street 1:12827 STATE ROAD TT
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4351
Practice Address - Country:US
Practice Address - Phone:636-352-1000
Practice Address - Fax:636-638-1189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-27
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility