Organization
ST. MARYS HEALTH CARE CENTER INVESTORS LLC
Active
Other names
Edwardsville Nursing and Rehabilitation Center
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BRIAN KNOOTZ (ADMINISTRATOR)
(618) 692-1330
Entity
Organization
Contact information
Practice address
401 SAINT MARYS DR, EDWARDSVILLE, IL 62025-4276
(618) 692-1330
(618) 692-9478
Mailing address
401 SAINT MARYS DR, EDWARDSVILLE, IL 62025-4276
(618) 692-1330
(618) 692-9478
Taxonomy
Speciality
Code
Description
License number
State
311Z00000X
Custodial Care Facility
—
—
314000000X
Skilled Nursing Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1558343301
NPI
IL
Enumeration date
11/17/2005
Last updated
10/02/2013
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