Provider Demographics
NPI:1790829802
Name:MMA HEALTHCARE OF CENTER, INC.
Entity Type:Organization
Organization Name:MMA HEALTHCARE OF CENTER, INC.
Other - Org Name:WESTVIEW NURSING HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:ASHWIN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNDOO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-543-3800
Mailing Address - Street 1:1869 CRAIG PARK CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-4122
Mailing Address - Country:US
Mailing Address - Phone:314-543-3800
Mailing Address - Fax:314-543-3880
Practice Address - Street 1:301 WEST DUNLOP ST
Practice Address - Street 2:
Practice Address - City:CENTER
Practice Address - State:MO
Practice Address - Zip Code:63436-0258
Practice Address - Country:US
Practice Address - Phone:573-267-3920
Practice Address - Fax:573-267-3216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO032424314000000X
MO037461314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO102762705Medicaid
MO265423Medicare Oscar/Certification