Healthcare Provider Details

I. General information

NPI: 1063923969
Provider Name (Legal Business Name): NORMANDY HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2017
Last Update Date: 10/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 SAINT CHARLES ROCK RD
SAINT LOUIS MO
63133-1737
US

IV. Provider business mailing address

477 N LINDBERGH BLVD STE 310
SAINT LOUIS MO
63141-7856
US

V. Phone/Fax

Practice location:
  • Phone: 314-862-0555
  • Fax:
Mailing address:
  • Phone: 314-631-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JUDAH BIENSTOCK
Title or Position: MANAGER
Credential:
Phone: 314-631-3000