Healthcare Provider Details

I. General information

NPI: 1942295803
Provider Name (Legal Business Name): DELMAR GARDENS OF O'FALLON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 03/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7068 S OUTER 364
O FALLON MO
63368-7757
US

IV. Provider business mailing address

14805 N OUTER 40 RD SUITE 300
CHESTERFIELD MO
63017-6060
US

V. Phone/Fax

Practice location:
  • Phone: 636-240-6100
  • Fax: 636-240-1182
Mailing address:
  • Phone: 636-733-7000
  • Fax: 636-733-7010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number044756
License Number StateMO

VIII. Authorized Official

Name: MR. GAIL LEE HARTMANN
Title or Position: TREASURER
Credential:
Phone: 636-733-7000