Phar, LLC

Primary specialty

Assisted Living FacilityTaxonomy code 310400000X

License

037148 Issued in MO

Legal business name

PHAR, LLC

Practice address

300 Autumn Ridge Drive
Herculaneum, MO 63048-1505

Phone

(636) 931-8400

Fax

(636) 933-3975

NPI assigned

Apr 10, 2009

Last updated

Jul 28, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Benjamin Klein

Title

Manager

Phone

(847) 329-4100

Specialties & licenses 1

Addresses

Other identifiers 1

Other names 1

• Autumn Ridge Other name

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1239321600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1248739200000",
    "number": "1801039524",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7444 LONG AVE",
            "city": "SKOKIE",
            "state": "IL",
            "postal_code": "600773214",
            "telephone_number": "847-329-4100",
            "fax_number": "847-329-7652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 AUTUMN RIDGE DRIVE",
            "city": "HERCULANEUM",
            "state": "MO",
            "postal_code": "630481505",
            "telephone_number": "636-931-8400",
            "fax_number": "636-933-3975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHAR, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-10",
        "last_updated": "2009-07-28",
        "status": "A",
        "authorized_official_last_name": "KLEIN",
        "authorized_official_first_name": "BENJAMIN",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "847-329-4100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "310400000X",
            "taxonomy_group": "",
            "desc": "Assisted Living Facility",
            "state": "MO",
            "license": "037148",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "M266744705",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Autumn Ridge",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Danielle Louise Limpert, MOT, OTR/L
• Amanda Denise McCormick, M.S., CCC-SLP
• Mallorie Miller
• Nextstep for Life, Inc
• Opportunities Without Limits Inc (O.W.L.)
• Catherine Rapp, M.S. - SLP
• Corrine Reeves, AUD
• Scenic Drive Dental Center
• Scenic Nursing and Rehabilitation Center, LLC
• Scenic Nursing and Rehabilitation Center, LLC

• Assisted Living Facility in Herculaneum, MO
• Providers in Herculaneum, MO by specialty
• Assisted Living Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.