Organization
OTKE-VILLA LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TOM OTKE (MEMBER)
(573) 659-6607
Entity
Organization
Contact information
Practice address
1030 EDMONDS ST, JEFFERSON CITY, MO 65109-5213
(573) 635-3381
(573) 635-6685
Mailing address
1030 EDMONDS ST, JEFFERSON CITY, MO 65109-5213
(573) 635-3381
(573) 635-6685
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
032359
MO
Other
Enumeration date
05/17/2006
Last updated
08/22/2020
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