Provider Demographics
NPI:1790789204
Name:DUTCHTOWN CARE CENTER INC
Entity Type:Organization
Organization Name:DUTCHTOWN CARE CENTER INC
Other - Org Name:DUTCHTOWN CARE AND REHABILITATION CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:LILY
Authorized Official - Middle Name:
Authorized Official - Last Name:LANDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-832-4700
Mailing Address - Street 1:3421 GASCONADE ST
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63118-4201
Mailing Address - Country:US
Mailing Address - Phone:314-832-4700
Mailing Address - Fax:314-832-7177
Practice Address - Street 1:3421 GASCONADE ST
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63118-4201
Practice Address - Country:US
Practice Address - Phone:314-832-4700
Practice Address - Fax:314-832-7177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-13
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO030951314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO113207OtherBLUE CROSS BLUE SHIELD
MO108598707Medicaid
MO7184988OtherUNITED HEALTHCARE
MO108598707Medicaid