Healthcare Provider Details

I. General information

NPI: 1437130747
Provider Name (Legal Business Name): FLO-GP LEASING CO., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 09/28/2022
Certification Date: 09/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S NEW FLORISSANT RD
FLORISSANT MO
63031-6716
US

IV. Provider business mailing address

4700 ASHWOOD DR SUITE 200
CINCINNATI OH
45241-2465
US

V. Phone/Fax

Practice location:
  • Phone: 314-838-2211
  • Fax: 314-838-5981
Mailing address:
  • Phone: 513-489-7100
  • Fax: 513-530-1359

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number030945
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: CHARLES STOLTZ
Title or Position: CFO
Credential:
Phone: 513-489-7100