Provider Demographics
NPI:1275675753
Name:WINCHESTER PLACE ASSISTED LIVING
Entity Type:Organization
Organization Name:WINCHESTER PLACE ASSISTED LIVING
Other - Org Name:WINCHESTER PLACE ASSISTED LIVING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:SELLS
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:573-293-6702
Mailing Address - Street 1:PO BOX 760
Mailing Address - Street 2:
Mailing Address - City:BERNIE
Mailing Address - State:MO
Mailing Address - Zip Code:63822-0760
Mailing Address - Country:US
Mailing Address - Phone:573-293-6705
Mailing Address - Fax:573-293-6710
Practice Address - Street 1:404 WINCHESTER DR
Practice Address - Street 2:
Practice Address - City:BERNIE
Practice Address - State:MO
Practice Address - Zip Code:63822-7500
Practice Address - Country:US
Practice Address - Phone:573-293-6705
Practice Address - Fax:573-293-6710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-13
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO049736OtherALF-II STATE LICENSE