Organization
COMMUNITY MANOR, LLC
Active
Other names
Community Manor
Organization subpart
No
Provider details
NPI number
Authorized official
DR. SHARO SHIRSHEKAN (CEO/MANAGING MEMBER)
(573) 701-0600
Entity
Organization
Contact information
Practice address
783 WEBER RD, FARMINGTON, MO 63640-3318
(573) 756-8998
(573) 756-8980
Mailing address
765 WEBER RD, FARMINGTON, MO 63640-3318
(573) 701-0600
(573) 701-0601
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
031312
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102481108
—
MO
Enumeration date
10/04/2006
Last updated
12/17/2013
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