Marymount Manor LLC
Skilled Nursing Facility in Eureka, MO. Organization (NPI-2).
NPI number1457412587
StatusActive
Last updated in NPPESDec 1, 2009
Details
- NPI
- 1457412587
- Entity type
- Organization (NPI-2)
- Legal business name
- Marymount Manor LLC
- Organization subpart
- No
- Enumeration date
- Dec 13, 2006
- Last updated
- Dec 1, 2009
Medicare and OIG
- Medicare enrolled (PECOS)
- Yes · PART A PROVIDER - SKILLED NURSING FACILITY
- Can order and refer
- Not on the CMS order and referring list
- OIG exclusion list
- This NPI is not listed
CMS and OIG files of November 2026. PECOS lookup · OIG exclusion check
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 314000000X | Skilled Nursing Facility | – | – | Yes |
Practice location
313 Augustine RdEureka, MO 63025-1935
Phone 636-938-6770 · Fax 636-938-3742
Mailing address
1749 Gilsinn LnFenton, MO 63026-2003
Phone 636-349-2311 · Fax 636-349-6491
Authorized official
Charles J Riley
Memeber
6363492311
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