MEDICARE: ST CLAIR NURSING 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	030993	MO

General Provider Information

NPI Number	:	1841297645
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST CLAIR NURSING LLC

Provider Business Mailing Address
First Line	:	1035 PLAZA CT N
Second Line	:
City	:	SAINT CLAIR
State	:	MO
Zip	:	63077-1129
Country	:	US
Telephone Number	:	636-629-2100
Fax Number	:	636-629-7793

Provider Business Practice Location Address
First Line	:	1035 PLAZA CT NORTH
Second Line	:
City	:	SAINT CLAIR
State	:	MO
Zip	:	63077-1129
Country	:	US
Telephone Number	:	636-629-2100
Fax Number	:	636-629-7793

Authorized Official
Title or Position	:	TREASURER
Name	:	MR. JAMES REIKER
Credential	:
Telephone Number	:	573-471-1113

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	01/29/2013

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Directions to “ST CLAIR NURSING LLC ” Practice Location

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