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NPI 1710358155

NPI 1710358155 : EMEREST HEATH OF MISSOURI LLC : O FALLON, MO

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General NPI Number Information
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    NPI Number           |    1710358155
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    Entity Type          |    Organization 
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    Legal Business Name  |    EMEREST HEATH OF MISSOURI LLC 
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Dates
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    Enumeration Date     |    10/12/2015
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    Last Update Date     |    10/12/2015
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Provider Practice Location Address
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    Address Line         |    731 HYDE DR 
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    City                 |    O FALLON
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    State                |    MO
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    Zip                  |    63366-7571
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    Country              |    US
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    Telephone            |    314-299-1380
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    Fax                  |    
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Provider Business Mailing Address
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    Address Line         |    731 HYDE DR 
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    City                 |    O FALLON
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    State                |    MO
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    Zip                  |    63366-7571
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    Country              |    US
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    Telephone            |    
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    Fax                  |    
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Authorized Official
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    Title or Position    |    MANAGER
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    Name                 |    MR. CHAIM SHIA KLEIN 
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    Credential           |    
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    Telephone            |    314-299-1380
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    376J00000X
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    Taxonomy Name        |    Homemaker
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    License Number       |    
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    License Number State |    
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