Organization
SENIORTRUST OF CHARLEVOIX, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT WEBB (PRESIDENT)
(615) 893-2749
Entity
Organization
Contact information
Practice address
1221 BOONES LICK RD, SAINT CHARLES, MO 63301-2328
(636) 946-6140
Mailing address
1221 BOONES LICK RD, SAINT CHARLES, MO 63301-2328
(636) 946-6140
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
031526
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
155063
BC BS MO
MO
01
—
229216
GHP ADVANTRA
—
01
—
265160
MERCY
—
01
—
7100076
UNITED HEALTH CARE
—
Enumeration date
05/23/2006
Last updated
08/22/2020
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