Organization
PHAR, LLC
Active
Other names
Autumn Ridge
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BENJAMIN KLEIN (MANAGER)
(847) 329-4100
Entity
Organization
Contact information
Practice address
300 AUTUMN RIDGE DRIVE, HERCULANEUM, MO 63048-1505
(636) 931-8400
(636) 933-3975
Mailing address
7444 LONG AVE, SKOKIE, IL 60077-3214
(847) 329-4100
(847) 329-7652
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
037148
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
M266744705
—
MO
Enumeration date
04/10/2009
Last updated
07/28/2009
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