Healthcare Provider Details

I. General information

NPI: 1225332851
Provider Name (Legal Business Name): MOUNT CARMEL COMMUNITIES O'FALLON, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/22/2010
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 N MAIN ST
O FALLON MO
63366-2276
US

IV. Provider business mailing address

206 N MAIN ST
O FALLON MO
63366-2276
US

V. Phone/Fax

Practice location:
  • Phone: 636-240-5754
  • Fax: 636-272-4324
Mailing address:
  • Phone: 636-240-5754
  • Fax: 636-272-4324

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: MR. C. C. BROWN
Title or Position: EXECUTIVE DIRECTOR
Credential: LNA
Phone: 636-240-5754