Provider Demographics
NPI:1619386034
Name:GARDEN VILLAS OF O'FALLON, LLC
Entity Type:Organization
Organization Name:GARDEN VILLAS OF O'FALLON, LLC
Other - Org Name:GARDEN VILLAS OF O'FALLON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:HARTMANN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-733-7000
Mailing Address - Street 1:14805 N OUTER 40 RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-6060
Mailing Address - Country:US
Mailing Address - Phone:636-733-7000
Mailing Address - Fax:636-733-7010
Practice Address - Street 1:7092 S OUTER ROAD 364
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-7701
Practice Address - Country:US
Practice Address - Phone:636-240-5560
Practice Address - Fax:636-240-4995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-11
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042170310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility