Provider Demographics
NPI:1659334167
Name:CAPE RETIREMENT COMMUNITY, INC.
Entity Type:Organization
Organization Name:CAPE RETIREMENT COMMUNITY, INC.
Other - Org Name:CHATEAU GIRARDEAU
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:BOELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-651-8186
Mailing Address - Street 1:3120 INDEPENDENCE ST
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-5043
Mailing Address - Country:US
Mailing Address - Phone:573-335-1281
Mailing Address - Fax:573-651-8184
Practice Address - Street 1:3120 INDEPENDENCE ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63703-5043
Practice Address - Country:US
Practice Address - Phone:573-335-1281
Practice Address - Fax:573-651-8184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-07
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031333310400000X
MO031705314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO107809105Medicaid
MO107809105Medicaid