Provider Demographics
NPI:1619287406
Name:FLORISSANT MEDICAL INVESTORS LLC
Entity Type:Organization
Organization Name:FLORISSANT MEDICAL INVESTORS LLC
Other - Org Name:HEALTHBRIDGE ST. LOUIS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROJECT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CLIFF
Authorized Official - Middle Name:R
Authorized Official - Last Name:HEELEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-458-3366
Mailing Address - Street 1:1201 GARDEN PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-2230
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1201 GARDEN PLAZA DRIVE
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-2230
Practice Address - Country:US
Practice Address - Phone:636-536-0285
Practice Address - Fax:636-536-9450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-14
Last Update Date:2021-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
265838Medicare Oscar/Certification