Healthcare Provider Details

I. General information

NPI: 1992435895
Provider Name (Legal Business Name): MERCY REHABILITATION HOSPITAL SOUTH LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2022
Last Update Date: 06/14/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10114 KENNERLY RD
ST LOUIS MO
63128-2183
US

IV. Provider business mailing address

10114 KENNERLY RD
ST LOUIS MO
63128-2183
US

V. Phone/Fax

Practice location:
  • Phone: 314-525-1000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283X00000X
TaxonomyRehabilitation Hospital
License Number
License Number State

VIII. Authorized Official

Name: DANIEL ECKENFELS
Title or Position: VP FINANCE
Credential:
Phone: 314-525-1483