{"npi":"1306028261","type":"NPI-2","status":"active","name":{"display":"Mma Healthcare Of St. Elizabeth, Inc.","other":[],"organization_name":"MMA HEALTHCARE OF ST. ELIZABETH, INC.","authorised_official":"Ashwin Dundoo"},"specialty":{"primary_taxonomy":"314000000X","primary_taxonomy_description":"Skilled Nursing Facility","slug":"skilled-nursing-facility","schema_org_specialty":null,"all":[{"code":"314000000X","description":"Skilled Nursing Facility","primary":false,"state":"MO","license":"034857"},{"code":"314000000X","description":"Skilled Nursing Facility","primary":true,"state":"MO","license":"038104"}]},"addresses":[{"purpose":"LOCATION","street_1":"649 S WALNUT STREET","city":"ST. ELIZABETH","state":"MO","postal_code":"650752440","country_code":"US","phone":"5734932215","fax":"5734932712"},{"purpose":"MAILING","street_1":"1869 CRAIG PARK CT","city":"SAINT LOUIS","state":"MO","postal_code":"631464122","country_code":"US","phone":"3145433800","fax":"3145433880"}],"license":{"state":"MO","number":"038104"},"identifiers":[{"type_code":"05","label":"Medicaid","value":"101477305","state":"MO","issuer":null}],"pecos":{"enrolled_at":"2026-05-09T10:41:39.028268+00:00","enrollments":[{"enrlmt_id":"O20080328000390","type_code":"00-18","type_desc":"PART A PROVIDER - SKILLED NURSING FACILITY","state":"MO","pac_id":"3476639584"}]},"enumeration_date":"2007-12-03","last_updated":"2013-04-04","_meta":{"source":"NPPES","snapshot_date":"2013-04-04","doc_url":"https://findmynpi.com/api"}}