Healthcare Provider Details

I. General information

NPI: 1720608284
Provider Name (Legal Business Name): MOTHER OF GOOD COUNSEL HOME
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2020
Last Update Date: 04/24/2020
Certification Date: 04/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6825 NATURAL BRIDGE RD
SAINT LOUIS MO
63121-5397
US

IV. Provider business mailing address

6825 NATURAL BRIDGE RD
SAINT LOUIS MO
63121-5397
US

V. Phone/Fax

Practice location:
  • Phone: 314-383-4765
  • Fax:
Mailing address:
  • Phone: 314-383-4765
  • Fax:

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: MARSHA T HEINE
Title or Position: OUTREACH COORDINATOR
Credential:
Phone: 314-383-4765