Basic Information
| Provider Information | |||||||||
| NPI: | 1801261375 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST. SOPHIA HEALTHCARE, LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ST. SOPHIA HEALTH & REHAB CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 CITYPLACE DR | ||||||||
| Address2: | STE. 430 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631417157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3146313000 | ||||||||
| FaxNumber: | 3149426634 | ||||||||
| Practice Location | |||||||||
| Address1: | 936 CHARBONIER RD | ||||||||
| Address2: | |||||||||
| City: | FLORISSANT | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630315220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3148314800 | ||||||||
| FaxNumber: | 3148311310 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/09/2015 | ||||||||
| LastUpdateDate: | 03/17/2016 | ||||||||
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| AuthorizedOfficialLastName: | JEREMIAS | ||||||||
| AuthorizedOfficialFirstName: | BARUCH | ||||||||
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| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 3146313000 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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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.