Healthcare Provider Details

I. General information

NPI: 1811106198
Provider Name (Legal Business Name): PHFM, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

627 WESTWOOD DR S
FESTUS MO
63028-2062
US

IV. Provider business mailing address

7444 LONG AVE
SKOKIE IL
60077-3214
US

V. Phone/Fax

Practice location:
  • Phone: 636-931-9066
  • Fax: 636-937-2019
Mailing address:
  • Phone: 847-329-4100
  • Fax: 847-329-4900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number033475
License Number StateMT

VIII. Authorized Official

Name: MR. BEN KLEIN
Title or Position: MANAGER
Credential:
Phone: 847-329-4100