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NPI Code Detail

MEDICARE: DELMAR GARDENS OF CREVE COEUR OPERATING, LLC

MEDICARE: DELMAR GARDENS OF CREVE COEUR OPERATING, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1314000000XSkilled Nursing Facility044994MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1265427124
Entity Type Code : Organization
Provider Name (Legal Business Name) : DELMAR GARDENS OF CREVE COEUR OPERATING, LLC
Provider Business Mailing Address
First Line : 14805 N OUTER 40 RD
Second Line : SUITE 300
City : CHESTERFIELD
State : MO
Zip : 63017-6060
Country : US
Telephone Number : 636-733-7000
Fax Number : 636-733-7010
Provider Business Practice Location Address
First Line : 850 COUNTRY MANOR LN
Second Line :
City : CREVE COEUR
State : MO
Zip : 63141-6651
Country : US
Telephone Number : 314-434-5900
Fax Number : 314-434-3927
Authorized Official
Title or Position : TREASURER
Name : MR. GAIL LEE HARTMANN
Credential :
Telephone Number : 636-733-7000
Provider Enumeration Date : 09/16/2005
Last Update Date : 03/13/2017

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