Provider Demographics
NPI:1013427780
Name:STEELVILLE SENIOR LIVING, LLC
Entity Type:Organization
Organization Name:STEELVILLE SENIOR LIVING, LLC
Other - Org Name:STEELVILLE SENIOR LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:R
Authorized Official - Last Name:JUCKETTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:660-214-0051
Mailing Address - Street 1:3225 EMERALD LN STE B
Mailing Address - Street 2:
Mailing Address - City:JEFFERSON CITY
Mailing Address - State:MO
Mailing Address - Zip Code:65109-6869
Mailing Address - Country:US
Mailing Address - Phone:573-556-6240
Mailing Address - Fax:573-556-6241
Practice Address - Street 1:311 N SPRING ST
Practice Address - Street 2:
Practice Address - City:STEELVILLE
Practice Address - State:MO
Practice Address - Zip Code:65565-5089
Practice Address - Country:US
Practice Address - Phone:573-556-6240
Practice Address - Fax:573-556-6241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-06
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO310400000X, 314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
No310400000XNursing & Custodial Care FacilitiesAssisted Living Facility