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General NPI Number Information
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NPI Number | 1316252430
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Entity Type | Organization
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Legal Business Name | BRENTMOOR DELMAR - SPVEF, LLC
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Dates
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Enumeration Date | 08/12/2010
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Last Update Date | 08/12/2010
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Provider Practice Location Address
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Address Line | 8600 DELMAR BLVD 12TH FLOOR
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City | SAINT LOUIS
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State | MO
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Zip | 63124-1973
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Country | US
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Telephone | 314-994-0432
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Fax | 314-692-0836
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Provider Business Mailing Address
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Address Line | 8600 DELMAR BLVD 12TH FLOOR
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City | SAINT LOUIS
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State | MO
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Zip | 63124-1973
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Country | US
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Telephone | 314-994-0432
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Fax | 314-692-0836
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Authorized Official
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Title or Position | MEMBER
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Name | MR. BARRY PESSIN
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Credential |
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Telephone | 314-994-0432
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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 | 037041
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License Number State | MO
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