MEDICARE: ELDERCARE OF THE VALLEY, 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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952308298
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELDERCARE OF THE VALLEY, INC

Provider Business Mailing Address
First Line	:	6768 N HIGHWAY 67
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63034-2742
Country	:	US
Telephone Number	:	636-477-3280
Fax Number	:	636-477-3241

Provider Business Practice Location Address
First Line	:	6768 N HIGHWAY 67
Second Line	:
City	:	FLORISSANT
State	:	MO
Zip	:	63034-2742
Country	:	US
Telephone Number	:	314-741-9101
Fax Number	:	314-741-4936

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	MR. MARK LIERMAN
Credential	:
Telephone Number	:	636-477-3280

Provider Enumeration Date	:	07/01/2005
Last Update Date	:	12/01/2020

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