Provider Demographics
NPI:1780064071
Name:NICK'S HEALTH CARE CENTER LLC
Entity type:Organization
Organization Name:NICK'S HEALTH CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IN-HOUSE COUNSEL
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:CRADDICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-543-3816
Mailing Address - Street 1:1869 CRAIG PARK CT
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63146-4122
Mailing Address - Country:US
Mailing Address - Phone:314-543-3816
Mailing Address - Fax:314-543-3880
Practice Address - Street 1:253 E HIGHWAY 116
Practice Address - Street 2:
Practice Address - City:PLATTSBURG
Practice Address - State:MO
Practice Address - Zip Code:64477-1561
Practice Address - Country:US
Practice Address - Phone:816-539-2376
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility