Healthcare Provider Details

I. General information

NPI: 1437419389
Provider Name (Legal Business Name): BENCHMARK HEALTHCARE OF ROLLA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2012
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 MCCUTCHEN RD
ROLLA MO
65401-2615
US

IV. Provider business mailing address

17826 EDISON AVE
CHESTERFIELD MO
63005-1262
US

V. Phone/Fax

Practice location:
  • Phone: 537-364-2311
  • Fax: 537-364-2748
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 Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: EMILY JACOBSMEYER
Title or Position: LEGAL ASSISTANT
Credential:
Phone: 636-449-8899