Healthcare Provider Details

I. General information

NPI: 1457894214
Provider Name (Legal Business Name): ST. LOUIS NH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2016
Last Update Date: 06/25/2021
Certification Date: 06/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11278 SCHUETZ RD
SAINT LOUIS MO
63146-4957
US

IV. Provider business mailing address

11278 SCHUETZ RD
SAINT LOUIS MO
63146-4957
US

V. Phone/Fax

Practice location:
  • Phone: 314-991-4066
  • Fax: 314-991-6852
Mailing address:
  • Phone: 314-991-4066
  • Fax: 314-991-6852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JAMES MASON
Title or Position: PRESIDENT
Credential:
Phone: 813-347-7425