Organization
ELDERCARE OF MID-MISSOURI IV, INC.
Active
Other names
StoneBridge De Soto
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK LIERMAN (SECRETARY - TREASURER)
(636) 477-3280
Entity
Organization
Contact information
Practice address
1550 VILLA DR, DE SOTO, MO 63020-2586
(636) 586-6559
Mailing address
1550 VILLA DR, DE SOTO, MO 63020-2586
(636) 477-3280
Taxonomy
Speciality
Code
Description
License number
State
251J00000X
Nursing Care Agency
035678
MO
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
107812307
—
MO
Enumeration date
05/19/2008
Last updated
12/01/2020
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