Organization
OMEGA LONG TERM CARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KIM L WYATT (OFFICE MANAGER)
(314) 808-5083
Entity
Organization
Contact information
Practice address
12800 BOENKER LN, BRIDGETON, MO 63044-2438
(314) 551-0338
(314) 551-0336
Mailing address
12800 BOENKER LN, BRIDGETON, MO 63044-2438
(314) 551-0338
(314) 551-0336
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
137743
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2001189801
—
MO
05
—
207937715
—
MO
05
—
2083138069
—
MO
05
—
429398209
—
MO
Enumeration date
07/24/2014
Last updated
07/24/2014
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