MEDICARE: NEELUM 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	310400000X	Assisted Living Facility	042872	MO

General Provider Information

NPI Number	:	1487044293
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEELUM LLC

Provider Business Mailing Address
First Line	:	13210 CLAYTON RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63131-1001
Country	:	US
Telephone Number	:	314-533-3111
Fax Number	:

Provider Business Practice Location Address
First Line	:	3610 PALM ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63107-2206
Country	:	US
Telephone Number	:	314-533-3111
Fax Number	:

Authorized Official
Title or Position	:	MEMBER LLC
Name	:	ALI CHAUDHRY
Credential	:
Telephone Number	:	314-533-3111

Provider Enumeration Date	:	02/01/2015
Last Update Date	:	02/01/2015

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