Organization
FRIENDSHIP VILLAGE OF SOUTH COUNTY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUE CHAMPION (OFFICER)
(314) 842-6840
Entity
Organization
Contact information
Practice address
12651 VILLAGE CIRCLE DR, SAINT LOUIS, MO 63127-1778
(314) 842-6840
(314) 525-7500
Mailing address
12651 VILLAGE CIRCLE DR, SAINT LOUIS, MO 63127-1778
(314) 842-6840
(314) 525-7500
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
030527
MO
314000000X
Skilled Nursing Facility
Primary
030733
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101486504
—
MO
Enumeration date
11/02/2005
Last updated
09/29/2020
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