Provider Demographics
NPI:1316064801
Name:BRENTMOOR RETIREMENT COMMUNITY
Entity type:Organization
Organization Name:BRENTMOOR RETIREMENT COMMUNITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF RESIDENT SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MERZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN, BSN, LNHA
Authorized Official - Phone:314-994-0432
Mailing Address - Street 1:8600 DELMAR BOULEVARD
Mailing Address - Street 2:12TH FLOOR
Mailing Address - City:ST. LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63124-1973
Mailing Address - Country:US
Mailing Address - Phone:314-995-3811
Mailing Address - Fax:314-995-3974
Practice Address - Street 1:8600 DELMAR BOULEVARD
Practice Address - Street 2:12TH FLOOR
Practice Address - City:ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63124-1973
Practice Address - Country:US
Practice Address - Phone:314-995-3811
Practice Address - Fax:314-995-3974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO031650310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility