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General NPI Number Information
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NPI Number | 1356565030
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Entity Type | Organization
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Legal Business Name | EBG HEALTH CARE I, INC.
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 06/24/2014
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Provider Practice Location Address
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Address Line | 2939 MAGAZINE ST
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City | SAINT LOUIS
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State | MO
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Zip | 63106-1245
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Country | US
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Telephone | 314-531-0500
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Fax | 314-531-5455
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Provider Business Mailing Address
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Address Line | 1505 E TRAFFICWAY ST
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City | SPRINGFIELD
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State | MO
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Zip | 65802-3174
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Country | US
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Telephone | 417-869-5522
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Fax | 417-831-7729
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Authorized Official
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Title or Position | CHIEF FINANCIAL OFFICER
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Name | MRS. CAROL L GOURLEY
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Credential |
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Telephone | 417-869-5522
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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 | 033709
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License Number State | MO
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