MEDICARE: JPAM CARE & REHABILITATION CENTER, INC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K204221020	OTHER	MO	DRIVERS LICENSE

General Provider Information

NPI Number	:	1912556606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JPAM CARE & REHABILITATION CENTER, INC

Provider Business Mailing Address
First Line	:	12832 BIG BEND RD
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63122-5104
Country	:	US
Telephone Number	:	314-374-7419
Fax Number	:

Provider Business Practice Location Address
First Line	:	3225 N FLORISSANT AVE
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63107-3521
Country	:	US
Telephone Number	:	314-374-7419
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN BRENCICK
Credential	:
Telephone Number	:	314-374-7419

Provider Enumeration Date	:	09/05/2019
Last Update Date	:	09/05/2019

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