Healthcare Provider Details

I. General information

NPI: 1437126208
Provider Name (Legal Business Name): JEFFERSON MEMORIAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 INDUSTRIAL DR
FESTUS MO
63028-4105
US

IV. Provider business mailing address

PO BOX 279
FESTUS MO
63028-0279
US

V. Phone/Fax

Practice location:
  • Phone: 636-933-1548
  • Fax: 636-933-1579
Mailing address:
  • Phone: 636-933-1548
  • Fax: 636-933-1579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DENNIS HALLEY
Title or Position: EXECUTIVE DIRECTOR OF OPERATIONS
Credential:
Phone: 636-933-1162