MEDICARE: THE WOODLANDS OF MARYLAND HEIGHTS 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	314000000X	Skilled Nursing Facility

Other Identifiers

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

General Provider Information

NPI Number	:	1487715793
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE WOODLANDS OF MARYLAND HEIGHTS LLC

Provider Business Mailing Address
First Line	:	1749 GILSINN LN
Second Line	:
City	:	FENTON
State	:	MO
Zip	:	63026-2003
Country	:	US
Telephone Number	:	636-349-2311
Fax Number	:	636-349-6491

Provider Business Practice Location Address
First Line	:	3201 PARKWOOD LN
Second Line	:
City	:	MARYLAND HEIGHTS
State	:	MO
Zip	:	63043-1334
Country	:	US
Telephone Number	:	314-291-5911
Fax Number	:	314-291-3576

Authorized Official
Title or Position	:	MEMEBER
Name	:	MR. CHARLES J RILEY
Credential	:
Telephone Number	:	636-349-2311

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	04/14/2014

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