Healthcare Provider Details

I. General information

NPI: 1366911711
Provider Name (Legal Business Name): PREFERRED FAMILY HEALTHCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2018
Last Update Date: 11/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 W CHURCH ST
AURORA MO
65605-1518
US

IV. Provider business mailing address

118 N 2ND ST
SAINT CHARLES MO
63301-2832
US

V. Phone/Fax

Practice location:
  • Phone: 417-467-0680
  • Fax: 417-678-1195
Mailing address:
  • Phone: 636-224-1210
  • Fax: 636-946-0991

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: THERESA MOYE
Title or Position: ENROLLMENT SPECIALIST
Credential:
Phone: 636-224-1210