Healthcare Provider Details

I. General information

NPI: 1851467039
Provider Name (Legal Business Name): ALEXIAN BROTHERS SHERBROOKE VILLAGE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4005 RIPA AVE
SAINT LOUIS MO
63125-2378
US

IV. Provider business mailing address

4005 RIPA AVE
SAINT LOUIS MO
63125-2378
US

V. Phone/Fax

Practice location:
  • Phone: 314-544-1111
  • Fax:
Mailing address:
  • Phone: 314-544-1111
  • 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: KELLIE GRONEFELD
Title or Position: COO
Credential:
Phone: 314-729-3500