Healthcare Provider Details

I. General information

NPI: 1114126232
Provider Name (Legal Business Name): REHABCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 07/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10600 LEWIS AND CLARK BLVD
SAINT LOUIS MO
63136-6005
US

IV. Provider business mailing address

1982 CATHEDRAL HILL DR
SAINT LOUIS MO
63138-1520
US

V. Phone/Fax

Practice location:
  • Phone: 314-340-6389
  • Fax:
Mailing address:
  • Phone: 314-355-9430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number116873
License Number StateMO

VIII. Authorized Official

Name: MS. PRISCILLA LEE GANT
Title or Position: PTA
Credential: PTA
Phone: 314-340-6389