1467585539 NPI number — GREEN ACRES HOME OF WEST PLAINS INC

Table of content: (NPI 1467585539)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467585539 NPI number — GREEN ACRES HOME OF WEST PLAINS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREEN ACRES HOME OF WEST PLAINS INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467585539
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 166
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEST PLAINS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65775-0166
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-257-0954
Provider Business Mailing Address Fax Number:
417-257-2982

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3280 COUNTY ROAD 4220
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST PLAINS
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65775-6436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
417-257-0954
Provider Business Practice Location Address Fax Number:
417-257-2982
Provider Enumeration Date:
03/14/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
NEWTON
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
417-257-0954

Provider Taxonomy Codes

  • Taxonomy code: 251C00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 385H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 385HR2060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

Other Provider's Identifiers (legacy, non-NPI)