Healthcare Provider Details

I. General information

NPI: 1942212899
Provider Name (Legal Business Name): GREEN VALLEY NURSING & REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 PRIGGE RD
SAINT LOUIS MO
63138-3543
US

IV. Provider business mailing address

211 N BROADWAY SUITE 2035
SAINT LOUIS MO
63102-2711
US

V. Phone/Fax

Practice location:
  • Phone: 314-741-9393
  • Fax: 314-438-8128
Mailing address:
  • Phone: 314-588-7518
  • Fax: 314-588-7321

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number036136
License Number StateMO

VIII. Authorized Official

Name: MR. MOSHE ORLINSKY
Title or Position: MANAGER
Credential:
Phone: 314-588-7518