MEDICARE: BEL OAK OF MT. VERNON, 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	:	1619682275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEL OAK OF MT. VERNON, LLC

Provider Business Mailing Address
First Line	:	437 SOVEREIGN CT
Second Line	:
City	:	BALLWIN
State	:	MO
Zip	:	63011-4432
Country	:	US
Telephone Number	:	636-394-3000
Fax Number	:

Provider Business Practice Location Address
First Line	:	1425 S LANDRUM ST
Second Line	:
City	:	MOUNT VERNON
State	:	MO
Zip	:	65712-1912
Country	:	US
Telephone Number	:	636-394-3000
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. CRAIG WEINER
Credential	:
Telephone Number	:	636-394-3000

Provider Enumeration Date	:	01/18/2023
Last Update Date	:	07/24/2024

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