Provider Demographics
NPI:1619837796
Name:SHELBINA VILLAGE ESTATES, INC
Entity type:Organization
Organization Name:SHELBINA VILLAGE ESTATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LLC MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:L
Authorized Official - Last Name:AMOS
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTER NURSE
Authorized Official - Phone:636-358-3593
Mailing Address - Street 1:301 SUNBROOK CT
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-4889
Mailing Address - Country:US
Mailing Address - Phone:636-358-3593
Mailing Address - Fax:636-462-6614
Practice Address - Street 1:218 E SHELBINA AVE
Practice Address - Street 2:
Practice Address - City:SHELBINA
Practice Address - State:MO
Practice Address - Zip Code:63468-4328
Practice Address - Country:US
Practice Address - Phone:573-588-4115
Practice Address - Fax:573-588-4115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-12
Last Update Date:2025-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility