Organization
DESOTO RESIDENTIAL CARE APTS INC
Active
Other names
THE VILLAS
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TOM OTKE (PRESIDENT OWNER)
(573) 659-6607
Entity
Organization
Contact information
Practice address
1550 VILLAS DRIVE, DESOTO, MO 63020-2586
(636) 586-6559
(636) 586-1604
Mailing address
1550 VILLAS DRIVE, DESOTO, MO 63020-2586
(636) 586-6559
(636) 586-1604
Taxonomy
Speciality
Code
Description
License number
State
313M00000X
Nursing Facility/Intermediate Care Facility
031261
MO
314000000X
Skilled Nursing Facility
Primary
031260
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
107812307
—
MO
05
—
266751809
—
MO
Enumeration date
11/28/2005
Last updated
06/30/2008
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