Provider Demographics
NPI:1457456667
Name:ST. PETERS MANOR, INC.
Entity Type:Organization
Organization Name:ST. PETERS MANOR, INC.
Other - Org Name:ST PETERS MANOR CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SCHEULEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-556-6240
Mailing Address - Street 1:230 SPENCER ROAD
Mailing Address - Street 2:
Mailing Address - City:ST PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63376
Mailing Address - Country:US
Mailing Address - Phone:636-441-2750
Mailing Address - Fax:636-447-2835
Practice Address - Street 1:230 SPENCER RD
Practice Address - Street 2:
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63376-2425
Practice Address - Country:US
Practice Address - Phone:636-441-2750
Practice Address - Fax:636-447-2835
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2016-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO019803SNF314000000X
MO0168041CF314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO106961105Medicaid
265589Medicare Oscar/Certification