Healthcare Provider Details

I. General information

NPI: 1710973136
Provider Name (Legal Business Name): BELLEFONTAINE GARDENS NURSING & REHAB, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2005
Last Update Date: 11/03/2011
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

9500 BELLEFONTAINE RD
SAINT LOUIS MO
63137-1336
US

V. Phone/Fax

Practice location:
  • Phone: 314-388-0796
  • Fax: 314-388-2654
Mailing address:
  • Phone: 314-388-0796
  • Fax: 314-388-2654

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number030826
License Number StateMO

VIII. Authorized Official

Name: MR. JAMES C LINCOLN
Title or Position: SHAREHOLDER
Credential:
Phone: 573-746-7100