Organization
ST JOE MANOR INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SHARO SHIRSHEKAN (PRESIDENT)
(573) 701-0600
Entity
Organization
Contact information
Practice address
10 LAKE DR, BONNE TERRE, MO 63628-1820
(573) 358-2800
(573) 358-1090
Mailing address
10 LAKE DR, BONNE TERRE, MO 63628-1820
(573) 358-2800
(573) 358-1090
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
031997
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
103256004
—
MO
Enumeration date
10/17/2006
Last updated
03/21/2019
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