Provider Demographics
NPI:1679901482
Name:CPLACE ST CHARLES SNF LLC
Entity Type:Organization
Organization Name:CPLACE ST CHARLES SNF LLC
Other - Org Name:CARRINGTON PLACE OF ST CHARLES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MS
Authorized Official - First Name:LYNDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:HEBBELN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:727-797-5200
Mailing Address - Street 1:310 10TH AVE N
Mailing Address - Street 2:
Mailing Address - City:SAFETY HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34695-3416
Mailing Address - Country:US
Mailing Address - Phone:727-797-5200
Mailing Address - Fax:727-797-3807
Practice Address - Street 1:2150 W RANDOLPH ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-0844
Practice Address - Country:US
Practice Address - Phone:636-946-4966
Practice Address - Fax:636-916-3386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-15
Last Update Date:2014-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
265518Medicare Oscar/Certification