Healthcare Provider Details

I. General information

NPI: 1609964618
Provider Name (Legal Business Name): PERRY OAKS NURSING & REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 03/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

430 N WEST ST
PERRYVILLE MO
63775-1359
US

IV. Provider business mailing address

211 N BROADWAY SUITE 2035
SAINT LOUIS MO
63102-2711
US

V. Phone/Fax

Practice location:
  • Phone: 573-547-1011
  • Fax: 573-547-7763
Mailing address:
  • Phone: 314-588-7518
  • Fax: 314-588-7321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number036011
License Number StateMO

VIII. Authorized Official

Name: MR. MOSHE ORLINSKY
Title or Position: MANAGER
Credential:
Phone: 314-588-7518