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NPI Code Detail

MEDICARE: ST. SOPHIA HEALTHCARE, LLC

MEDICARE: ST. SOPHIA HEALTHCARE, 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
1314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1801261375
Entity Type Code : Organization
Provider Name (Legal Business Name) : ST. SOPHIA HEALTHCARE, LLC
Provider Business Mailing Address
First Line : 6 CITYPLACE DR
Second Line : STE. 430
City : SAINT LOUIS
State : MO
Zip : 63141-7157
Country : US
Telephone Number : 314-631-3000
Fax Number : 314-942-6634
Provider Business Practice Location Address
First Line : 936 CHARBONIER RD
Second Line :
City : FLORISSANT
State : MO
Zip : 63031-5220
Country : US
Telephone Number : 314-831-4800
Fax Number : 314-831-1310
Authorized Official
Title or Position : MEMBER
Name : BARUCH JEREMIAS
Credential :
Telephone Number : 314-631-3000
Provider Enumeration Date : 12/09/2015
Last Update Date : 03/17/2016

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Directions to “ST. SOPHIA HEALTHCARE, LLC ” Practice Location

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