Healthcare Provider Details

I. General information

NPI: 1932188083
Provider Name (Legal Business Name): CITIZENS MEMORIAL HEALTH CARE FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1218 W LOCUST ST
BOLIVAR MO
65613-1312
US

IV. Provider business mailing address

1500 N OAKLAND AVE
BOLIVAR MO
65613-3011
US

V. Phone/Fax

Practice location:
  • Phone: 417-326-7648
  • Fax: 417-328-6336
Mailing address:
  • Phone: 417-326-6000
  • Fax: 417-328-6242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number031980
License Number StateMO

VIII. Authorized Official

Name: MRS. RENEE MARIE MEYER
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 417-328-6258