Provider Demographics
NPI:1477616183
Name:ARBOR PLACE OF CLINTON INC
Entity Type:Organization
Organization Name:ARBOR PLACE OF CLINTON INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:SELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-536-5365
Mailing Address - Street 1:1795 CLARKSON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-4967
Mailing Address - Country:US
Mailing Address - Phone:636-536-5365
Mailing Address - Fax:636-536-4533
Practice Address - Street 1:106 PADGETT DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:KY
Practice Address - Zip Code:42031-1313
Practice Address - Country:US
Practice Address - Phone:636-536-5365
Practice Address - Fax:636-536-4533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2009-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100181314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12504486Medicaid
KY185452Medicare Oscar/Certification