| NPI | 1073518924 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARRY VANDER MATEN President 314-994-9070 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: IL 0036798) |
| Additional Taxonomies | 332BP3500X Durable Medical Equipment & Medical Supplies Parenteral & Enteral Nutrition (Licence: IL 1303720001) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2008-04-20 |