Provider Demographics
NPI:1275590432
Name:SJMDHS, LLC
Entity Type:Organization
Organization Name:SJMDHS, LLC
Other - Org Name:MERCY CONTINUING CARE HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:VEILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-277-2330
Mailing Address - Street 1:13190 S OUTER 40
Mailing Address - Street 2:LEVEL I
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5917
Mailing Address - Country:US
Mailing Address - Phone:314-392-6380
Mailing Address - Fax:314-392-6379
Practice Address - Street 1:13190 S OUTER 40
Practice Address - Street 2:LEVEL I
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5917
Practice Address - Country:US
Practice Address - Phone:314-392-6380
Practice Address - Fax:314-392-6379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2013-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO498-0282E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282E00000XHospitalsLong Term Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO7572911OtherAETNA PIN
MO401054OtherHEALTHLINK
MO1385744OtherAETNA PVN
MO013805700Medicaid
MO207853OtherBLUE CROSS BLUE SHIELD
MO401054OtherHEALTHLINK