1851881692 NPI number — SRZ OP ST. LOUIS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851881692 NPI number — SRZ OP ST. LOUIS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SRZ OP ST. LOUIS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ST. LOUIS PLACE HEALTH & REHABILITATION
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851881692
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
22 HERRICK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWRENCE
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11559-1528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
929-928-0307
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2600 REDMAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAINT LOUIS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63136-5863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
314-355-8585
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/17/2018

Additional Information

Authorized Official

Authorized Official Last Name:
GOLDNER
Authorized Official First Name:
SAMUEL
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED PERSON/OFFICIAL
Authorized Official Telephone Number:
347-677-0448

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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