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NPI Code Detail

MEDICARE: NEOSHO RESIDENTIAL, LLC

MEDICARE: NEOSHO RESIDENTIAL, LLC
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 Facility

General Provider Information

NPI Number : 1689621435
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEOSHO RESIDENTIAL, LLC
Provider Business Mailing Address
First Line : 1105 VILLAGE RD
Second Line :
City : NEOSHO
State : MO
Zip : 64850-9076
Country : US
Telephone Number : 417-451-1000
Fax Number :
Provider Business Practice Location Address
First Line : 1105 VILLAGE RD
Second Line :
City : NEOSHO
State : MO
Zip : 64850-9076
Country : US
Telephone Number : 417-451-1000
Fax Number :
Authorized Official
Title or Position : MANAGER
Name : KYLE TIMOTHY SCHADE
Credential :
Telephone Number : 573-471-1113
Provider Enumeration Date : 05/27/2006
Last Update Date : 03/10/2026

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Directions to “NEOSHO RESIDENTIAL, LLC ” Practice Location

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