Provider Demographics
NPI:1952308298
Name:ELDERCARE OF THE VALLEY, INC
Entity Type:Organization
Organization Name:ELDERCARE OF THE VALLEY, INC
Other - Org Name:STONEBRIDGE FLORISSANT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:LIERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-477-3280
Mailing Address - Street 1:6768 N HIGHWAY 67
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63034-2742
Mailing Address - Country:US
Mailing Address - Phone:636-477-3280
Mailing Address - Fax:636-477-3241
Practice Address - Street 1:6768 N HIGHWAY 67
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63034-2742
Practice Address - Country:US
Practice Address - Phone:314-741-9101
Practice Address - Fax:314-741-4936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO102684909Medicaid
265365Medicare Oscar/Certification
MO5443120001Medicare NSC