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General NPI Number Information
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NPI Number | 1033994983
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Entity Type | Organization
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Legal Business Name | 4TH GENERATION RCF LLC
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Dates
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Enumeration Date | 08/29/2023
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Last Update Date | 08/29/2023
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Provider Practice Location Address
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Address Line | 2320 HUDSON RD
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City | SAINT LOUIS
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State | MO
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Zip | 63136-5608
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Country | US
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Telephone | 314-971-9784
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Fax | 314-382-2094
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Provider Business Mailing Address
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Address Line | 3258 REX AVE
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City | SAINT LOUIS
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State | MO
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Zip | 63114-2927
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Country | US
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Telephone | 314-971-9784
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Fax | 314-382-2094
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. NACOLE M TAYLOR
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Credential |
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Telephone | 314-971-9784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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