Healthcare Provider Details

I. General information

NPI: 1790404267
Provider Name (Legal Business Name): FESTUS MO OPCO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2022
Last Update Date: 08/26/2022
Certification Date: 08/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 WESTWOOD DR S
FESTUS MO
63028-2062
US

IV. Provider business mailing address

9722 GROFFS MILL DR
OWINGS MILLS MD
21117-6341
US

V. Phone/Fax

Practice location:
  • Phone: 636-931-9066
  • Fax:
Mailing address:
  • Phone: 443-742-8167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: DOVID INSEL
Title or Position: REGIONAL DIRECTOR OF OPERATIONS
Credential:
Phone: 443-742-8167