St Joe Manor Inc

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

031997 Issued in MO

Legal business name

ST JOE MANOR INC

Practice address

10 Lake Dr
Bonne Terre, MO 63628-1820

Phone

(573) 358-2800

Fax

(573) 358-1090

NPI assigned

Oct 17, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sharo Shirshekan

Title

President

Phone

(573) 701-0600

Specialties & licenses 1

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1553126400000",
    "number": "1144301144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10 LAKE DR",
            "city": "BONNE TERRE",
            "state": "MO",
            "postal_code": "636281820",
            "telephone_number": "573-358-2800",
            "fax_number": "573-358-1090"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10 LAKE DR",
            "city": "BONNE TERRE",
            "state": "MO",
            "postal_code": "636281820",
            "telephone_number": "573-358-2800",
            "fax_number": "573-358-1090"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ST JOE MANOR INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2019-03-21",
        "status": "A",
        "authorized_official_last_name": "SHIRSHEKAN",
        "authorized_official_first_name": "SHARO",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "573-701-0600"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "031997",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "103256004",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Taylor Lynn Siebert
• Roxanne Marie Simmons, M.A., CCC-SLP
• Annetta Slover
• Michelle D Spray, O.D.
• Cheyenne Spurgin, PTA
• Lacey Sullivan, FNP-BC
• Katelyn Abigail Swaringim
• Town & Country Grocers of Fredericktown Mo Inc
• Visage Studios, LLC
• Walgreen Co

• Skilled Nursing Facility in Bonne Terre, MO
• Providers in Bonne Terre, MO by specialty
• Skilled Nursing Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 21, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.