MEDICARE: BELLEFONTAINE GARDENS HEALTH CARE CENTER 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

General Provider Information

NPI Number	:	1558741835
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BELLEFONTAINE GARDENS HEALTH CARE CENTER LLC

Provider Business Mailing Address
First Line	:	1869 CRAIG PARK CT
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-4122
Country	:	US
Telephone Number	:	314-543-3816
Fax Number	:	314-543-3880

Provider Business Practice Location Address
First Line	:	9500 BELLEFONTAINE RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63137-1336
Country	:	US
Telephone Number	:	314-388-0796
Fax Number	:

Authorized Official
Title or Position	:	IN-HOUSE COUNSEL
Name	:	MR. ROBERT J CRADDICK
Credential	:
Telephone Number	:	314-543-3816

Provider Enumeration Date	:	06/02/2015
Last Update Date	:	06/02/2015

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