Healthcare Provider Details

I. General information

NPI: 1326217217
Provider Name (Legal Business Name): BEAUVAIS MANOR HEALTHCARE & REHAB CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2008
Last Update Date: 07/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3625 MAGNOLIA AVE
SAINT LOUIS MO
63110-4048
US

IV. Provider business mailing address

7434 SKOKIE BLVD
SKOKIE IL
60077-3341
US

V. Phone/Fax

Practice location:
  • Phone: 314-771-2990
  • Fax: 314-771-7960
Mailing address:
  • Phone: 847-982-2300
  • Fax: 847-982-2304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number035624
License Number StateMO

VIII. Authorized Official

Name: SHELDON WOLFE
Title or Position: MEMBER
Credential:
Phone: 847-982-2300