MEDICARE: SAN FRANCISCO TEMPLE MULTIPLEX

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	311Z00000X	Custodial Care Facility	392	MO

General Provider Information

NPI Number	:	1851593461
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SAN FRANCISCO TEMPLE MULTIPLEX

Provider Business Mailing Address
First Line	:	5341 EMERSON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63120-2511
Country	:	US
Telephone Number	:	314-383-4863
Fax Number	:	314-381-4255

Provider Business Practice Location Address
First Line	:	5341 EMERSON AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63120-2511
Country	:	US
Telephone Number	:	314-383-4863
Fax Number	:	314-381-4255

Authorized Official
Title or Position	:	ASSISTANT ADMINISTRATOR
Name	:	MR. YVONNE CECELIA HENDERSON
Credential	:	R.N.
Telephone Number	:	314-383-4863

Provider Enumeration Date	:	06/05/2007
Last Update Date	:	04/01/2008

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