Provider Demographics
NPI:1013305127
Name:ELDERCARE OF MID-MISSOURI XIII INC.
Entity Type:Organization
Organization Name:ELDERCARE OF MID-MISSOURI XIII INC.
Other - Org Name:STONEBRIDGE HERMANN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-477-3280
Mailing Address - Street 1:2500 S OLD HIGHWAY 94
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5616
Mailing Address - Country:US
Mailing Address - Phone:636-477-3280
Mailing Address - Fax:636-477-3241
Practice Address - Street 1:1800 WEIN ST
Practice Address - Street 2:
Practice Address - City:HERMANN
Practice Address - State:MO
Practice Address - Zip Code:65041-1601
Practice Address - Country:US
Practice Address - Phone:636-477-3280
Practice Address - Fax:636-477-3241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-26
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility