Healthcare Provider Details

I. General information

NPI: 1083026124
Provider Name (Legal Business Name): ROYAL OAK NURSING AND REHAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2014
Last Update Date: 05/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4960 LACLEDE AVE
SAINT LOUIS MO
63108-1404
US

IV. Provider business mailing address

4960 LACLEDE AVE
SAINT LOUIS MO
63108-1404
US

V. Phone/Fax

Practice location:
  • Phone: 314-361-6240
  • Fax:
Mailing address:
  • Phone: 314-361-6240
  • 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: MARIA HAIGHT
Title or Position: CONTROLLER
Credential:
Phone: 708-798-2272