Healthcare Provider Details

I. General information

NPI: 1336270701
Provider Name (Legal Business Name): PREFERRED FAMILY HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 03/09/2023
Certification Date: 03/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 W LOCKLING ST
BROOKFIELD MO
64628-2003
US

IV. Provider business mailing address

1601 OLD SOUTH RIVER RD
SAINT CHARLES MO
63303-4120
US

V. Phone/Fax

Practice location:
  • Phone: 660-258-4188
  • Fax:
Mailing address:
  • Phone: 636-224-1210
  • Fax: 636-246-1008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number6300-9238
License Number StateMO

VIII. Authorized Official

Name: MARK CONOVER
Title or Position: CHIEF REVENUE OFFICER
Credential:
Phone: 573-603-1460