Healthcare Provider Details

I. General information

NPI: 1861511297
Provider Name (Legal Business Name): ASTORIA GARDENS AND REHAB CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 03/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8220 DELMAR BLVD SUITE 210
SAINT LOUIS MO
63124-2174
US

IV. Provider business mailing address

8220 DELMAR BLVD SUITE 210
SAINT LOUIS MO
63124-2174
US

V. Phone/Fax

Practice location:
  • Phone: 314-692-0777
  • Fax: 314-692-0406
Mailing address:
  • Phone: 314-692-0777
  • Fax: 314-692-0406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number1783042
License Number StateIL

VIII. Authorized Official

Name: MR. STEVEN R AXELBAUM
Title or Position: ADMINISTRATOR
Credential:
Phone: 309-329-1333