1891901831 NPI number — BRISTOL CARE, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891901831 NPI number — BRISTOL CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRISTOL CARE, 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:
BRISTOL MANOR OF WENTZVILLE
Provider Other Organization Name Type Code:
5
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:
1891901831
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 W 3RD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEDALIA
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65301-4352
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-826-0200
Provider Business Mailing Address Fax Number:
660-827-2027

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
840 W NORTHVIEW AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WENTZVILLE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
63385-1036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
636-639-6777
Provider Business Practice Location Address Fax Number:
636-639-6777
Provider Enumeration Date:
05/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EBELING
Authorized Official First Name:
SHELLEY
Authorized Official Middle Name:
D
Authorized Official Title or Position:
MEDICAID BILLING DEPARTMENT
Authorized Official Telephone Number:
660-826-0200

Provider Taxonomy Codes

  • Taxonomy code: 310400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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