Healthcare Provider Details

I. General information

NPI: 1942829692
Provider Name (Legal Business Name): CCM OPERATIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2020
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 TIMBER RUN DR
SAINT LOUIS MO
63146-4482
US

IV. Provider business mailing address

1 UNIVERSITY PLZ STE 500
HACKENSACK NJ
07601-6203
US

V. Phone/Fax

Practice location:
  • Phone: 314-434-8361
  • Fax:
Mailing address:
  • Phone: 201-470-5751
  • 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: BENJAMIN M KLEIN
Title or Position: AUTHORIZED PERSON
Credential:
Phone: 201-470-5751