Organization
FLO-GP LEASING CO., LLC
Active
Other names
Crystal Creek Health and Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLES STOLTZ (CFO)
(513) 489-7100
Entity
Organization
Contact information
Practice address
250 S NEW FLORISSANT RD, FLORISSANT, MO 63031-6716
(314) 838-2211
(314) 838-5981
Mailing address
4700 ASHWOOD DR, SUITE 200, CINCINNATI, OH 45241-2465
(513) 489-7100
(513) 530-1359
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
030945
MO
320700000X
Physical Disabilities Residential Treatment Facility
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
107807703
—
MO
Enumeration date
11/14/2005
Last updated
09/28/2022
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