MEDICARE: BEZALEEL PERFECTIONS 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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1619133204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEZALEEL PERFECTIONS LLC

Provider Business Mailing Address
First Line	:	1201 GARDEN VILLAGE DR
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-1962
Country	:	US
Telephone Number	:	314-583-3427
Fax Number	:

Provider Business Practice Location Address
First Line	:	1201 GARDEN VILLAGE DR
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63031-1962
Country	:	US
Telephone Number	:	314-583-3427
Fax Number	:

Authorized Official
Title or Position	:	PRINCIPAL
Name	:	MS. MARY OSUMA
Credential	:
Telephone Number	:	314-583-3427

Provider Enumeration Date	:	08/02/2008
Last Update Date	:	08/05/2008

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