MEDICARE: LANDMARK HOSPITAL OF CAPE GIRARDEAU TRANSITIONAL CARE CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility

General Provider Information

NPI Number	:	1134663503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LANDMARK HOSPITAL OF CAPE GIRARDEAU TRANSITIONAL CARE CENTER, LLC

Provider Business Mailing Address
First Line	:	3255 INDEPENDENCE ST
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-4914
Country	:	US
Telephone Number	:	573-335-1091
Fax Number	:

Provider Business Practice Location Address
First Line	:	3255 INDEPENDENCE ST
Second Line	:
City	:	CAPE GIRARDEAU
State	:	MO
Zip	:	63701-4914
Country	:	US
Telephone Number	:	573-335-1091
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	KEN WARRINER
Credential	:
Telephone Number	:	239-529-1802

Provider Enumeration Date	:	12/05/2016
Last Update Date	:	12/05/2016

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