NPI 1104127844

Ellisville Rehab Center, INC

Organisation Exclusive Provider Organization Ellisville, MO

Practice location

Address: 16075 Manchester Rd, Ellisville, MO 63011-2103
Phone: (636) 256-0880
Fax: (636) 256-9153

Authorised official

Name: Leslie Anne Siess
Title: Owner
Phone: (636) 256-0880

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence 26-6639 (MO)

Other Exclusive Provider Organization providers in Missouri →

Registry record

NPI: 1104127844
Entity type: Organization
NPI issued: 11 Nov 2010
Record last updated: 11 Nov 2010

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.