Provider Demographics
NPI:1760457683
Name:SHALIMAR CORP. D/B/A PARKWOOD MANOR
Entity type:Organization
Organization Name:SHALIMAR CORP. D/B/A PARKWOOD MANOR
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GALE
Authorized Official - Middle Name:A
Authorized Official - Last Name:LACY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-335-3044
Mailing Address - Street 1:2732 BLOOMFIELD RD
Mailing Address - Street 2:
Mailing Address - City:CAPE GIRARDEAU
Mailing Address - State:MO
Mailing Address - Zip Code:63703-6302
Mailing Address - Country:US
Mailing Address - Phone:573-335-3044
Mailing Address - Fax:573-335-6724
Practice Address - Street 1:325 N SPRIGG ST
Practice Address - Street 2:
Practice Address - City:CAPE GIRARDEAU
Practice Address - State:MO
Practice Address - Zip Code:63701-5531
Practice Address - Country:US
Practice Address - Phone:573-334-7011
Practice Address - Fax:573-334-7011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO371-75453104A0625X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3104A0625XNursing & Custodial Care FacilitiesAssisted Living FacilityAssisted Living, Mental Illness