Healthcare Provider Details

I. General information

NPI: 1114050887
Provider Name (Legal Business Name): KABUL NURSING HOMES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 OZARK AVE
CABOOL MO
65689-9358
US

IV. Provider business mailing address

1101 OZARK AVE
CABOOL MO
65689-9358
US

V. Phone/Fax

Practice location:
  • Phone: 417-962-3713
  • Fax: 417-962-4947
Mailing address:
  • Phone: 417-962-3713
  • Fax: 417-962-4947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number033625
License Number StateMO

VIII. Authorized Official

Name: MR. TOM COATS
Title or Position: PRESIDENT, BOARD OF DIRECTORS
Credential:
Phone: 417-962-3713