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NPI Code Detail

MEDICARE: MERCY REHAB AND CARE CENTER, INC.

MEDICARE: MERCY REHAB AND CARE CENTER, INC.
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
1332BP3500XParenteral & Enteral Nutrition Supplies (DME)1303590001IL
2314000000XSkilled Nursing Facility0032680IL

General Provider Information

NPI Number : 1568467306
Entity Type Code : Organization
Provider Name (Legal Business Name) : MERCY REHAB AND CARE CENTER, INC.
Provider Business Mailing Address
First Line : 11861 WESTLINE INDUSTRIAL DR
Second Line : SUITE 150
City : SAINT LOUIS
State : MO
Zip : 63146-3305
Country : US
Telephone Number : 314-548-2250
Fax Number :
Provider Business Practice Location Address
First Line : 100 ROSEWOOD VILLAGE DR
Second Line :
City : SWANSEA
State : IL
Zip : 62226-2301
Country : US
Telephone Number : 618-236-1391
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : LARRY VANDER MATEN
Credential :
Telephone Number : 314-548-2250
Provider Enumeration Date : 06/17/2005
Last Update Date : 02/16/2017

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