Provider Demographics
NPI:1932522737
Name:OAK PARK HEALTHCARE LLC
Entity Type:Organization
Organization Name:OAK PARK HEALTHCARE LLC
Other - Org Name:OAK PARK CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JUDAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BIENSTOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-631-3000
Mailing Address - Street 1:6637 BERTHOLD AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-3318
Mailing Address - Country:US
Mailing Address - Phone:314-781-3444
Mailing Address - Fax:314-781-6139
Practice Address - Street 1:6637 BERTHOLD AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63139-3318
Practice Address - Country:US
Practice Address - Phone:314-781-3444
Practice Address - Fax:314-781-6139
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-29
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO265427Medicare Oscar/Certification