Community Manor, LLC

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

031312 Issued in MO

Legal business name

COMMUNITY MANOR, LLC

Doing business as

Community Manor

Practice address

783 Weber Rd
Farmington, MO 63640-3318

Phone

(573) 756-8998

Fax

(573) 756-8980

NPI assigned

Oct 4, 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

Dr. Sharo Shirshekan

Title

Ceo/Managing Member

Phone

(573) 701-0600

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Community Manor Doing business as

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

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1387238400000",
    "number": "1801981089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "765 WEBER RD",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636403318",
            "telephone_number": "573-701-0600",
            "fax_number": "573-701-0601"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "783 WEBER RD",
            "city": "FARMINGTON",
            "state": "MO",
            "postal_code": "636403318",
            "telephone_number": "573-756-8998",
            "fax_number": "573-756-8980"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "COMMUNITY MANOR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-04",
        "last_updated": "2013-12-17",
        "status": "A",
        "authorized_official_last_name": "SHIRSHEKAN",
        "authorized_official_first_name": "SHARO",
        "authorized_official_title_or_position": "CEO/MANAGING MEMBER",
        "authorized_official_telephone_number": "573-701-0600",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "MO",
            "license": "031312",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102481108",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Community Manor",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Skilled Nursing Facility in Farmington, MO
• Providers in Farmington, 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.