Healthcare Provider Details

I. General information

NPI: 1558741835
Provider Name (Legal Business Name): BELLEFONTAINE GARDENS HEALTH CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2015
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 BELLEFONTAINE RD
SAINT LOUIS MO
63137-1336
US

IV. Provider business mailing address

1869 CRAIG PARK CT
SAINT LOUIS MO
63146-4122
US

V. Phone/Fax

Practice location:
  • Phone: 314-388-0796
  • Fax:
Mailing address:
  • Phone: 314-543-3816
  • Fax: 314-543-3880

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. ROBERT J CRADDICK
Title or Position: IN-HOUSE COUNSEL
Credential:
Phone: 314-543-3816