1700919941 NPI number — N&CO HOMECARE LLC

Table of content: (NPI 1700919941)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700919941 NPI number — N&CO HOMECARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
N&CO HOMECARE LLC
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:
HOMECARE OF MID MISSOURI HOSPICE
Provider Other Organization Name Type Code:
3
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:
1700919941
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
175 HUNTERS GLENN LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KIMBERLING CITY
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65686-9863
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
417-350-4931
Provider Business Mailing Address Fax Number:
660-263-2737

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 WEST REED STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBERLY
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65270-1555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-263-1517
Provider Business Practice Location Address Fax Number:
660-263-2737
Provider Enumeration Date:
03/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ROBERTSON
Authorized Official First Name:
BOBBY
Authorized Official Middle Name:
GERALD
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
417-350-4931

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 237405893 . This is a "MERCY HEALTH PLANS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 32078 . This is a "BLUE CHOICE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 12938 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 237405893 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 581684701 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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