Healthcare Provider Details

I. General information

NPI: 1992991897
Provider Name (Legal Business Name): BRAVO CARE OF ST LOUIS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2007
Last Update Date: 12/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11278 SCHUETZ RD
SAINT LOUIS MO
63146-4957
US

IV. Provider business mailing address

11701 BORMAN DR STE 315
SAINT LOUIS MO
63146-4194
US

V. Phone/Fax

Practice location:
  • Phone: 314-991-4066
  • Fax:
Mailing address:
  • Phone:
  • 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: ALEKSANDRA SAVIC
Title or Position: AR DIRECTOR
Credential:
Phone: 314-994-9070