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General NPI Number Information
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NPI Number | 1194970343
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Entity Type | Organization
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Legal Business Name | BENCHMARK HEALTHCARE OF PORTAGEVILLE, LLC
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Dates
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Enumeration Date | 12/01/2008
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Last Update Date | 01/27/2014
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Provider Practice Location Address
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Address Line | 290 W STATE HIGHWAY 162
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City | PORTAGEVILLE
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State | MO
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Zip | 63873-9397
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Country | US
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Telephone | 573-379-2017
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Fax | 573-379-2735
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Provider Business Mailing Address
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Address Line | 17826 EDISON AVE
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City | CHESTERFIELD
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State | MO
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Zip | 63005-1262
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Country | US
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Telephone | 636-536-5365
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Fax | 636-536-4533
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JOHN M. SELLS
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Credential |
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Telephone | 636-536-5365
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 035353
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License Number State | MO
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