Organization
PORTAGEVILLE HEALTH CARE CENTER, L.L.C.
Active
Other names
PORTAGEVILLE HEALTH CARE CENTER
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD J. DESTEFANE (PRESIDENT)
(314) 543-3800
Entity
Organization
Contact information
Practice address
290 W STATE HIGHWAY 162, PORTAGEVILLE, MO 63873-9397
(573) 379-2017
(573) 379-2735
Mailing address
1869 CRAIG PARK CT, SAINT LOUIS, MO 63146-4122
(314) 543-3816
(314) 543-3880
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
LC001502456
MO
Other
Enumeration date
08/30/2016
Last updated
08/30/2016
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