Organization
ALTON MEMORIAL HOSPITAL
Active
Other names
Eunice Smith Home, Alton Memorial Rehab & Therapy
Organization subpart
No
Provider details
NPI number
Authorized official
MR. DAVID A BRAASCH (PRESIDENT)
(618) 463-7301
Entity
Organization
Contact information
Practice address
1251 COLLEGE AVE, ALTON, IL 62002-6735
(618) 463-7330
(618) 463-7332
Mailing address
11133 DUNN RD, PFD 2ND FLOOR SUITE 2179, SAINT LOUIS, MO 63136-6119
(314) 653-4093
(314) 653-4077
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
0008409
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000709
BLUE CROSS BLUE SHIELD
—
01
—
46497
GHP
—
01
—
7100035
UNITED HEALTHCARE
—
Enumeration date
07/27/2006
Last updated
03/22/2021
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