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NPI Code Detail

MEDICARE: KING CITY HEALTHCARE, LLC

MEDICARE: KING CITY HEALTHCARE, 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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1245605211
Entity Type Code : Organization
Provider Name (Legal Business Name) : KING CITY HEALTHCARE, LLC
Provider Business Mailing Address
First Line : 6 CITYPLACE DR
Second Line : SUITE 430
City : SAINT LOUIS
State : MO
Zip : 63141-7157
Country : US
Telephone Number : 314-631-3000
Fax Number : 314-942-6634
Provider Business Practice Location Address
First Line : 300 W FAIRVIEW ST
Second Line :
City : KING CITY
State : MO
Zip : 64463-9606
Country : US
Telephone Number : 660-535-4325
Fax Number :
Authorized Official
Title or Position : MEMBER
Name : JUDAH BIENSTOCK
Credential :
Telephone Number : 314-631-3000
Provider Enumeration Date : 12/02/2015
Last Update Date : 12/02/2015

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Directions to “KING CITY HEALTHCARE, LLC ” Practice Location

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