Provider Demographics
NPI:1437419389
Name:BENCHMARK HEALTHCARE OF ROLLA, LLC
Entity Type:Organization
Organization Name:BENCHMARK HEALTHCARE OF ROLLA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LEGAL ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBSMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-449-8899
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:636-536-5365
Mailing Address - Fax:636-536-4533
Practice Address - Street 1:1200 MCCUTCHEN RD
Practice Address - Street 2:
Practice Address - City:ROLLA
Practice Address - State:MO
Practice Address - Zip Code:65401-2615
Practice Address - Country:US
Practice Address - Phone:537-364-2311
Practice Address - Fax:537-364-2748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-25
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
MO265844Medicare Oscar/Certification