Healthcare Provider Details

I. General information

NPI: 1255493623
Provider Name (Legal Business Name): BENCHMARK HEALTHCARE OF FESTUS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2006
Last Update Date: 11/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12827 HIGHWAY TT
FESTUS MO
63028-4351
US

IV. Provider business mailing address

17826 EDISON AVE
CHESTERFIELD MO
63005-1262
US

V. Phone/Fax

Practice location:
  • Phone: 636-536-5365
  • Fax: 636-536-4533
Mailing address:
  • Phone: 636-536-5365
  • Fax: 636-536-4533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number032784
License Number StateMO

VIII. Authorized Official

Name: JOHN M. SELLS
Title or Position: PRESIDENT
Credential:
Phone: 636-536-5365