MEDICARE: JAMIESON CARE 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
1	3104A0630X	Assisted Living Facility (Behavioral Disturbances)	040469	MO

General Provider Information

NPI Number	:	1356698930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JAMIESON CARE LLC

Provider Business Mailing Address
First Line	:	3715 JAMIESON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-1109
Country	:	US
Telephone Number	:	314-781-0222
Fax Number	:	888-836-1101

Provider Business Practice Location Address
First Line	:	3715 JAMIESON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63109-1109
Country	:	US
Telephone Number	:	314-781-0222
Fax Number	:	888-836-1101

Authorized Official
Title or Position	:	MANAGER
Name	:	JAMES HERBST
Credential	:
Telephone Number	:	636-448-3781

Provider Enumeration Date	:	08/13/2012
Last Update Date	:	08/13/2012

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