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NPI Code Detail

MEDICARE: MONETT HEALTH CARE LLC

MEDICARE: MONETT HEALTH CARE 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
1314000000XSkilled Nursing Facility

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700211042
Entity Type Code : Organization
Provider Name (Legal Business Name) : MONETT HEALTH CARE LLC
Provider Business Mailing Address
First Line : 920 RIDGEBROOK RD
Second Line :
City : SPARKS
State : MD
Zip : 21152-9390
Country : US
Telephone Number : 410-773-1000
Fax Number :
Provider Business Practice Location Address
First Line : 410 W BENTON ST
Second Line :
City : MONETT
State : MO
Zip : 65708-1608
Country : US
Telephone Number : 573-364-2311
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : KAM MCGAVOCK
Credential :
Telephone Number : 410-773-1000
Provider Enumeration Date : 09/05/2013
Last Update Date : 05/16/2014

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Directions to “MONETT HEALTH CARE LLC ” Practice Location

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