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General NPI Number Information
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NPI Number | 1780290288
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Entity Type | Organization
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Legal Business Name | CEDARHURST OF QUINCY OPERATOR, LLC
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Dates
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Enumeration Date | 09/20/2020
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Last Update Date | 09/20/2020
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Provider Practice Location Address
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Address Line | 319 S 48TH ST
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City | QUINCY
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State | IL
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Zip | 62305-0593
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Country | US
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Telephone | 217-577-2019
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Fax |
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Provider Business Mailing Address
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Address Line | 300 HUNTER AVE STE 200
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City | SAINT LOUIS
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State | MO
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Zip | 63124-2328
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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 | CONTROLLER
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Name | JESSICA GRIFFIN
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Credential |
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Telephone | 314-884-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 311500000X
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Taxonomy Name | Alzheimer Center (Dementia Center)
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License Number |
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License Number State |
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