MEDICARE: CORI MANOR HEALTHCARE & REHABILITATION 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	035712	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821258443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CORI MANOR HEALTHCARE & REHABILITATION CENTER, LLC

Provider Business Mailing Address
First Line	:	560 CORISANDE HILLS RD
Second Line	:
City	:	FENTON
State	:	MO
Zip	:	63026-5613
Country	:	US
Telephone Number	:	636-343-2282
Fax Number	:

Provider Business Practice Location Address
First Line	:	560 CORISANDE HILLS RD
Second Line	:
City	:	FENTON
State	:	MO
Zip	:	63026-5613
Country	:	US
Telephone Number	:	636-343-2282
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. MAKHLOUF SUISSA
Credential	:
Telephone Number	:	314-963-7570

Provider Enumeration Date	:	06/17/2008
Last Update Date	:	12/15/2010

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