Organization
PARC PROVENCE MANAGEMENT, L.L.C.
Active
Other names
Parc Provence
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARCIA AZAR RN, LNHA (ADMINISTRATOR)
(314) 542-2500
Entity
Organization
Contact information
Practice address
605 COEUR DE VILLE DR, CREVE COEUR, MO 63141-6603
(314) 542-2500
(314) 453-7840
Mailing address
605 COEUR DE VILLE DR, CREVE COEUR, MO 63141-6603
(314) 542-2500
(314) 453-7840
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
032612
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
032612
SNF LICENSE NO.
MO
01
—
106129406
PROVIDER NUMBER
MO
01
—
24122A
FACILITY NUMBER
MO
Enumeration date
03/26/2007
Last updated
06/17/2008
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