Provider Demographics
NPI:1841297645
Name:ST CLAIR NURSING LLC
Entity type:Organization
Organization Name:ST CLAIR NURSING LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:REIKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-471-1113
Mailing Address - Street 1:1035 PLAZA CT N
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR
Mailing Address - State:MO
Mailing Address - Zip Code:63077-1129
Mailing Address - Country:US
Mailing Address - Phone:636-629-2100
Mailing Address - Fax:636-629-7793
Practice Address - Street 1:1035 PLAZA CT NORTH
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR
Practice Address - State:MO
Practice Address - Zip Code:63077-1129
Practice Address - Country:US
Practice Address - Phone:636-629-2100
Practice Address - Fax:636-629-7793
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO030993314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
265495Medicare Oscar/Certification