Organization
EDGEWOOD MANOR HEALTH CARE CENTER, L.L.C.
Active
Other names
Edgewood Manor Health Care Center
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD J. DESTEFANE (PRESIDENT)
(314) 543-3816
Entity
Organization
Contact information
Practice address
11900 JESSICA LN, RAYTOWN, MO 64138-2649
(816) 358-7858
(816) 356-7775
Mailing address
1869 CRAIG PARK CT, SAINT LOUIS, MO 63146-4122
(314) 543-3816
(314) 226-1736
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Enumeration date
04/22/2020
Last updated
04/22/2020
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