Provider Demographics
NPI:1700054962
Name:ST. LOUIS SENIOR REHABILITATION
Entity Type:Organization
Organization Name:ST. LOUIS SENIOR REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:LAIBEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-604-7449
Mailing Address - Street 1:7618 OAK CREST CT
Mailing Address - Street 2:
Mailing Address - City:BARNHART
Mailing Address - State:MO
Mailing Address - Zip Code:63012-1871
Mailing Address - Country:US
Mailing Address - Phone:314-604-7449
Mailing Address - Fax:636-942-4040
Practice Address - Street 1:7618 OAK CREST CT
Practice Address - Street 2:
Practice Address - City:BARNHART
Practice Address - State:MO
Practice Address - Zip Code:63012-1871
Practice Address - Country:US
Practice Address - Phone:314-604-7449
Practice Address - Fax:636-942-4040
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-11
Last Update Date:2008-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)