Provider Demographics
NPI:1598009185
Name:VILLAGE CENTER CARE OF WENTZVILLE LLC
Entity Type:Organization
Organization Name:VILLAGE CENTER CARE OF WENTZVILLE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:ELLEN
Authorized Official - Last Name:GETTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MA GERENTOLOGY, NHA
Authorized Official - Phone:636-219-3114
Mailing Address - Street 1:909 E PITMAN AVE
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-1818
Mailing Address - Country:US
Mailing Address - Phone:636-327-1907
Mailing Address - Fax:
Practice Address - Street 1:909 E PITMAN AVE
Practice Address - Street 2:
Practice Address - City:WENTZVILLE
Practice Address - State:MO
Practice Address - Zip Code:63385-1818
Practice Address - Country:US
Practice Address - Phone:636-327-1907
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-20
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO040664310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility