Creve Coeur Manor LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

031651 Issued in MO

Legal business name

CREVE COEUR MANOR LLC

Practice address

1127 Timber Run Dr
Saint Louis, MO 63146-4482

Phone

(314) 434-8361

Fax

(314) 434-7785

NPI assigned

Oct 17, 2006

Last updated

Dec 17, 2013By the provider in NPPES

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

Managing Member

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": "1387238400000",
    "number": "1194806109",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1127 TIMBER RUN DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631464482",
            "telephone_number": "314-434-8361",
            "fax_number": "314-434-7785"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1127 TIMBER RUN DR",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631464482",
            "telephone_number": "314-434-8361",
            "fax_number": "314-434-7785"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CREVE COEUR MANOR LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-17",
        "last_updated": "2013-12-17",
        "status": "A",
        "authorized_official_last_name": "SHIRSHEKAN",
        "authorized_official_first_name": "SHARO",
        "authorized_official_title_or_position": "MANAGING MEMBER",
        "authorized_official_telephone_number": "573-701-0600"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "031651",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "101486009",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Crestwood Back and Neck Pain Clinic
• Crestwood Consultants, Inc. (Yvonne I. DeHart)
• Crestwood Dental Group Maxwell DMD PC (Crestwood Dental Group)
• Allison Marie Creswell, PA-C
• Creve Coeur Manor Health Care Center LLC
• Creve Coeur Oral Surgery
• Creve Coeur Psychiatric Services
• Crews Dental LLC
• Crews Dental LLC
• Crews Dental LLC

• Skilled Nursing Facility in Saint Louis, MO
• Providers in Saint Louis, 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 Dec 17, 2013; 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.