Provider Demographics
NPI:1780679555
Name:CATHEDRAL GARDENS CARE CENTER
Entity Type:Organization
Organization Name:CATHEDRAL GARDENS CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MDS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:ALICE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHUKUKERE
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:314-355-8585
Mailing Address - Street 1:2600 REDMAN RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63136-5863
Mailing Address - Country:US
Mailing Address - Phone:314-355-8585
Mailing Address - Fax:314-355-4645
Practice Address - Street 1:2600 REDMAN RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-5863
Practice Address - Country:US
Practice Address - Phone:314-355-8585
Practice Address - Fax:314-355-4645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031388314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO18697OtherFAC. ID
MO265586Medicare ID - Type Unspecified