Provider Demographics
NPI:1750759270
Name:WINDSOR ESTATES OF ST CHARLES SNAL, LLC
Entity type:Organization
Organization Name:WINDSOR ESTATES OF ST CHARLES SNAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LACEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-670-4737
Mailing Address - Street 1:2150 W RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-0844
Mailing Address - Country:US
Mailing Address - Phone:636-946-4966
Mailing Address - Fax:
Practice Address - Street 1:2150 W RANDOPLPH ST
Practice Address - Street 2:
Practice Address - City:ST CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-8738
Practice Address - Country:US
Practice Address - Phone:636-946-4966
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-15
Last Update Date:2021-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO265518Medicare PIN