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NPI Code Detail

MEDICARE: ST. LOUIS NH LLC

MEDICARE: ST. LOUIS NH 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 Facility

General Provider Information

NPI Number : 1457894214
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST. LOUIS NH LLC
Provider Business Mailing Address
First Line : 11278 SCHUETZ RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63146-4957
Country : US
Telephone Number : 314-991-4066
Fax Number : 314-991-6852
Provider Business Practice Location Address
First Line : 11278 SCHUETZ RD
Second Line :
City : SAINT LOUIS
State : MO
Zip : 63146-4957
Country : US
Telephone Number : 314-991-4066
Fax Number : 314-991-6852
Authorized Official
Title or Position : PRESIDENT
Name : JAMES MASON
Credential :
Telephone Number : 813-347-7425
Provider Enumeration Date : 11/28/2016
Last Update Date : 06/25/2021

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