MEDICARE: HHCP OE LP

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	311Z00000X	Custodial Care Facility

General Provider Information

NPI Number	:	1538633243
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HHCP OE LP

Provider Business Mailing Address
First Line	:	300 AUTUMN RIDGE DR
Second Line	:
City	:	HERCULANEUM
State	:	MO
Zip	:	63048-1506
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 AUTUMN RIDGE DR
Second Line	:
City	:	HERCULANEUM
State	:	MO
Zip	:	63048-1506
Country	:	US
Telephone Number	:	636-931-8400
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MR. MATTHEW FOX
Credential	:
Telephone Number	:	636-931-8400

Provider Enumeration Date	:	01/15/2019
Last Update Date	:	01/15/2019

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