Basic Information
| Provider Information | |||||||||
| NPI: | 1003106840 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BENCHMARK HEALTHCARE OF ST CHARLES, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17826 EDISON AVE | ||||||||
| Address2: | |||||||||
| City: | CHESTERFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630051262 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6364491795 | ||||||||
| FaxNumber: | 6365364533 | ||||||||
| Practice Location | |||||||||
| Address1: | 2840 W CLAY ST | ||||||||
| Address2: | |||||||||
| City: | SAINT CHARLES | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633012536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6369466100 | ||||||||
| FaxNumber: | 6369400998 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2011 | ||||||||
| LastUpdateDate: | 11/08/2013 | ||||||||
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| AuthorizedOfficialLastName: | SELLS | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | M. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6365365365 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
No ID Information.