Provider Demographics
NPI:1083736763
Name:OREM HEALTHCARE LLC DBA SUN VALLEY ADULT CARE CENTER
Entity Type:Organization
Organization Name:OREM HEALTHCARE LLC DBA SUN VALLEY ADULT CARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ROMANA
Authorized Official - Middle Name:
Authorized Official - Last Name:AFTAB
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-698-3479
Mailing Address - Street 1:1000 SAINT CYR RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63137-1733
Mailing Address - Country:US
Mailing Address - Phone:314-868-2232
Mailing Address - Fax:314-868-8075
Practice Address - Street 1:3452 MIDDLEBURY WAY
Practice Address - Street 2:
Practice Address - City:BELLEVILLE
Practice Address - State:IL
Practice Address - Zip Code:62221-3372
Practice Address - Country:US
Practice Address - Phone:314-868-2232
Practice Address - Fax:314-868-8075
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2017-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
320900000X
MO632385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO293895702Medicaid