1316937733 NPI number — GOWER CONVALESCENT CENTER INC

Table of content: (NPI 1316937733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316937733 NPI number — GOWER CONVALESCENT CENTER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOWER CONVALESCENT CENTER 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:
1316937733
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 170
Provider Second Line Business Mailing Address:
323 SOUTH 169 HIGHWAY
Provider Business Mailing Address City Name:
GOWER
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64454-0170
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-424-6483
Provider Business Mailing Address Fax Number:
816-424-6209

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
323 SOUTH 169 HIGHWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GOWER
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64454-0170
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-424-6483
Provider Business Practice Location Address Fax Number:
816-424-6209
Provider Enumeration Date:
10/26/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
POTTIER
Authorized Official First Name:
PAUL
Authorized Official Middle Name:
E
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
816-424-6483

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  032473 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 26E290 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".