Provider Demographics
NPI:1265420079
Name:JEWISH CENTER FOR AGED
Entity type:Organization
Organization Name:JEWISH CENTER FOR AGED
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CONTROLLER
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BARROW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-434-3330
Mailing Address - Street 1:13190 S OUTER 40
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5917
Mailing Address - Country:US
Mailing Address - Phone:314-434-3330
Mailing Address - Fax:314-392-6286
Practice Address - Street 1:13190 S OUTER 40
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5917
Practice Address - Country:US
Practice Address - Phone:314-434-3330
Practice Address - Fax:314-392-6286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031593314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO110925OtherBLUE CROSS
265071Medicare ID - Type Unspecified
MO110925OtherBLUE CROSS