Provider Demographics
NPI:1295281517
Name:HARBOR PLACE ESTATES, LLC
Entity type:Organization
Organization Name:HARBOR PLACE ESTATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:GETTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-219-3114
Mailing Address - Street 1:1054 S STATE HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63383
Mailing Address - Country:US
Mailing Address - Phone:314-377-4444
Mailing Address - Fax:314-377-4446
Practice Address - Street 1:1054 S STATE HIGHWAY 47
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383
Practice Address - Country:US
Practice Address - Phone:314-377-4444
Practice Address - Fax:314-377-4446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO044167310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1598009185Medicaid
MO1346695582Medicaid
MOM266733401Medicaid