Provider Demographics
NPI:1225332851
Name:MOUNT CARMEL COMMUNITIES O'FALLON, LLC
Entity Type:Organization
Organization Name:MOUNT CARMEL COMMUNITIES O'FALLON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:C.
Authorized Official - Middle Name:C
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LNA
Authorized Official - Phone:636-240-5754
Mailing Address - Street 1:206 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63366-2276
Mailing Address - Country:US
Mailing Address - Phone:636-240-5754
Mailing Address - Fax:636-272-4324
Practice Address - Street 1:206 N MAIN ST
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2276
Practice Address - Country:US
Practice Address - Phone:636-240-5754
Practice Address - Fax:636-272-4324
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-22
Last Update Date:2016-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility