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General NPI Number Information
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NPI Number | 1861878092
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Entity Type | Organization
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Legal Business Name | GERIATRIC PRACTITIONER SERVICES, LLC
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Dates
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Enumeration Date | 08/11/2015
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Last Update Date | 08/11/2015
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Provider Practice Location Address
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Address Line | 11361 BRIERHALL CIR
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City | MARYLAND HEIGHTS
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State | MO
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Zip | 63043-5002
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Country | US
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Telephone | 314-753-6714
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Fax |
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Provider Business Mailing Address
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Address Line | 11361 BRIERHALL CIR
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City | MARYLAND HEIGHTS
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State | MO
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Zip | 63043-5002
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Country | US
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Telephone | 314-753-6714
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. CATHERINE ANN KUSH
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Credential | DNP, GNP-BC
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Telephone | 314-753-6714
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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 | 118164
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License Number State | MO
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