Provider Demographics
NPI:1003106840
Name:BENCHMARK HEALTHCARE OF ST CHARLES, LLC
Entity Type:Organization
Organization Name:BENCHMARK HEALTHCARE OF ST CHARLES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:M
Authorized Official - Last Name:SELLS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-536-5365
Mailing Address - Street 1:17826 EDISON AVE
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-1262
Mailing Address - Country:US
Mailing Address - Phone:636-449-1795
Mailing Address - Fax:636-536-4533
Practice Address - Street 1:2840 W CLAY ST
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2536
Practice Address - Country:US
Practice Address - Phone:636-946-6100
Practice Address - Fax:636-940-0998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO265118Medicare Oscar/Certification