Healthcare Provider Details

I. General information

NPI: 1326709502
Provider Name (Legal Business Name): PALLADIAN CREVE COEUR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2022
Last Update Date: 03/18/2024
Certification Date: 03/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1127 TIMBER RUN DR
SAINT LOUIS MO
63146-4482
US

IV. Provider business mailing address

500 NW PLAZA DR STE 712
SAINT ANN MO
63074-2222
US

V. Phone/Fax

Practice location:
  • Phone: 314-434-8361
  • Fax:
Mailing address:
  • Phone: 314-317-2003
  • 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: MR. MICHAEL JASON MILLS
Title or Position: CFO
Credential:
Phone: 314-317-2003