Healthcare Provider Details

I. General information

NPI: 1326204298
Provider Name (Legal Business Name): SISTERS SUPPORTIVE SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2008
Last Update Date: 03/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 RYAN ST STE T
BOONVILLE MO
65233-1894
US

IV. Provider business mailing address

520 RYAN ST STE T
BOONVILLE MO
65233-1894
US

V. Phone/Fax

Practice location:
  • Phone: 660-882-2535
  • Fax:
Mailing address:
  • Phone: 660-882-2535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: AMBER DANIELLE CONZ
Title or Position: ADMINISTRATOR
Credential:
Phone: 660-882-2535