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NPI Code Detail

MEDICARE: BSLC II

MEDICARE: BSLC II
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1310400000XAssisted Living Facility039726MO

General Provider Information

NPI Number : 1215209226
Entity Type Code : Organization
Provider Name (Legal Business Name) : BSLC II
Provider Business Mailing Address
First Line : 1302 WEST SUNSET
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65807-5943
Country : US
Telephone Number : 417-889-7600
Fax Number : 417-889-2477
Provider Business Practice Location Address
First Line : 1302 WEST SUNSET
Second Line :
City : SPRINGFIELD
State : MO
Zip : 65807-5943
Country : US
Telephone Number : 417-889-7600
Fax Number : 417-889-2477
Authorized Official
Title or Position : DIRECTOR OF ACCOUNTING
Name : DIANE MARIE WILSON
Credential :
Telephone Number : 719-481-0100
Provider Enumeration Date : 02/07/2012
Last Update Date : 02/07/2012

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Directions to “BSLC II ” Practice Location

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