Provider Demographics
NPI:1760006308
Name:SUNTERRA DARDENNE PRAIRIE OC LLC
Entity Type:Organization
Organization Name:SUNTERRA DARDENNE PRAIRIE OC LLC
Other - Org Name:SUNTERRA SPRINGS DARDENNE PRAIRIE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GOVERNING BODY CHAIR
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SNOWBALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-397-4000
Mailing Address - Street 1:598 W 900 S STE 220
Mailing Address - Street 2:
Mailing Address - City:WOODS CROSS
Mailing Address - State:UT
Mailing Address - Zip Code:84010-8195
Mailing Address - Country:US
Mailing Address - Phone:801-397-4697
Mailing Address - Fax:
Practice Address - Street 1:7275 HIGHWAY N
Practice Address - Street 2:
Practice Address - City:DARDENNE PRAIRIE
Practice Address - State:MO
Practice Address - Zip Code:63368-7126
Practice Address - Country:US
Practice Address - Phone:686-865-0200
Practice Address - Fax:636-865-0201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-29
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility