Provider Demographics
NPI:1609964618
Name:PERRY OAKS NURSING & REHABILITATION CENTER LLC
Entity Type:Organization
Organization Name:PERRY OAKS NURSING & REHABILITATION CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:MOSHE
Authorized Official - Middle Name:
Authorized Official - Last Name:ORLINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-588-7518
Mailing Address - Street 1:211 N BROADWAY
Mailing Address - Street 2:SUITE 2035
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63102-2711
Mailing Address - Country:US
Mailing Address - Phone:314-588-7518
Mailing Address - Fax:314-588-7321
Practice Address - Street 1:430 N WEST ST
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:MO
Practice Address - Zip Code:63775-1359
Practice Address - Country:US
Practice Address - Phone:573-547-1011
Practice Address - Fax:573-547-7763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO036011314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO101479004Medicaid
MO265704Medicare Oscar/Certification