Healthcare Provider Details

I. General information

NPI: 1285879437
Provider Name (Legal Business Name): BENCHMARK HEALTHCARE OF GREENVILLE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2008
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 SYCAMORE ST
GREENVILLE MO
63944-0108
US

IV. Provider business mailing address

17826 EDISON AVE
CHESTERFIELD MO
63005-1262
US

V. Phone/Fax

Practice location:
  • Phone: 573-224-3298
  • Fax:
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 Number036277
License Number StateMO

VIII. Authorized Official

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