Provider Demographics
NPI:1497951412
Name:ST. ANDREWS & BETHESDA LLC
Entity type:Organization
Organization Name:ST. ANDREWS & BETHESDA LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:KIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREGRIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-800-1900
Mailing Address - Street 1:12101 WOODCREST EXECUTIVE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-5047
Mailing Address - Country:US
Mailing Address - Phone:314-800-1900
Mailing Address - Fax:314-900-3683
Practice Address - Street 1:12101 WOODCREST EXECUTIVE DR STE 200
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-5047
Practice Address - Country:US
Practice Address - Phone:314-800-1900
Practice Address - Fax:314-900-3683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-26
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
267613Medicare Oscar/Certification