Healthcare Provider Details

I. General information

NPI: 1770395162
Provider Name (Legal Business Name): BEL OAK OF HUDSON HOUSE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2025
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227 WINDING OAKS LN
MASCOUTAH IL
62258-1635
US

IV. Provider business mailing address

1700B S HUDSON AVE
AURORA MO
65605-2717
US

V. Phone/Fax

Practice location:
  • Phone: 618-566-4100
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: CRAIG WEINER
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 417-678-2169