1871658799 NPI number — HEALTH CARE CONSULTANTS OF MID MISSOURI, 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 1871658799 NPI number — HEALTH CARE CONSULTANTS OF MID MISSOURI, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH CARE CONSULTANTS OF MID MISSOURI, 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:
MAPLELAWN RESIDENTIAL CARE FACILITY
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:
1871658799
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:
420 CTY. RD. 112
Provider Second Line Business Mailing Address:
PO BOX 271
Provider Business Mailing Address City Name:
FAYETTE
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65248
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
660-248-3626
Provider Business Mailing Address Fax Number:
660-248-2166

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 COUNTY ROAD 112
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FAYETTE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65248
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
660-248-3626
Provider Business Practice Location Address Fax Number:
660-248-2166
Provider Enumeration Date:
12/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RUDROFF
Authorized Official First Name:
DARLA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
573-489-0246

Provider Taxonomy Codes

  • Taxonomy code: 3104A0625X , with the licence number:  2516-9032 , 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)





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