Alexian Brothers Sherbrooke Village

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

Legal business name

ALEXIAN BROTHERS SHERBROOKE VILLAGE

Doing business as

Ascension Living Sherbrooke Village

Practice address

4005 Ripa Ave
Saint Louis, MO 63125-2378

Phone

(314) 544-1111

NPI assigned

Nov 28, 2006

Last updated

Jun 28, 2024By 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

Kellie Gronefeld

Title

Coo

Phone

(314) 729-3500

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Ascension Living Sherbrooke Village Doing business as

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Panduranga Rao Koya, M.D.

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1427151323
  NPD (past)
• Patrick Joseph McCann, MD

  • Internal Medicine Physician
  • Saint Louis, MO
  • NPI 1437275963
  NPD (past)
• Russell KL Won, M.D.

  • General Practice Physician
  • Saint Louis, MO
  • NPI 1245327725
  NPD (past)

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

{
    "created_epoch": "1164672000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1719532800000",
    "number": "1851467039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4005 RIPA AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631252378",
            "telephone_number": "314-544-1111"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4005 RIPA AVE",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631252378",
            "telephone_number": "314-544-1111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALEXIAN BROTHERS SHERBROOKE VILLAGE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-28",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A",
        "authorized_official_last_name": "GRONEFELD",
        "authorized_official_first_name": "KELLIE",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "314-729-3500"
    },
    "taxonomies": [
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS",
            "identifier": "128655",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "102781804",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Ascension Living Sherbrooke Village",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Samantha Alexander, LCSW
• Shauncia Renee Alexander, RRT
• Alexian Brothers Comm SVCS Pharmacy (Alexian Brothers Community Services Pharmacy)
• Alexian Brothers Community Services of St. Louis
• Alexian Brothers Lansdowne Village
• Georgios Alexopoulos, MD
• Alfa Serenity Adult Daycare LLC
• Alfa Serenity IHS LLC
• Alfa Serenity LLC
• Etihad Shakir Alfalahi, M.D.

• Skilled Nursing Facility in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• Skilled Nursing Facility in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2024; 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.