Provider Demographics
NPI:1215919162
Name:ARBOR PLACE OF DEXTER, INC.
Entity type:Organization
Organization Name:ARBOR PLACE OF DEXTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SELLS
Authorized Official - Suffix:
Authorized Official - Credentials:MANAGEMENT COMPANY
Authorized Official - Phone:636-536-5365
Mailing Address - Street 1:1795 CLARKSON RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-4975
Mailing Address - Country:US
Mailing Address - Phone:636-535-5365
Mailing Address - Fax:636-536-4533
Practice Address - Street 1:13134 HWY 25
Practice Address - Street 2:
Practice Address - City:DEXTER
Practice Address - State:MO
Practice Address - Zip Code:63841-9740
Practice Address - Country:US
Practice Address - Phone:636-536-5365
Practice Address - Fax:636-536-4533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2008-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO029719310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO266735406Medicaid