Organization
MARYMOUNT MANOR LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. CHARLES J RILEY (MEMEBER)
(636) 349-2311
Entity
Organization
Contact information
Practice address
313 AUGUSTINE RD, EUREKA, MO 63025-1935
(636) 938-6770
(636) 938-3742
Mailing address
1749 GILSINN LN, FENTON, MO 63026-2003
(636) 349-2311
(636) 349-6491
Taxonomy
Speciality
Code
Description
License number
State
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101491009
—
MO
Enumeration date
12/13/2006
Last updated
12/01/2009
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