Healthcare Provider Details

I. General information

NPI: 1770590812
Provider Name (Legal Business Name): KABUL NURSING HOMES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 MAIN ST
CABOOL MO
65689-9125
US

IV. Provider business mailing address

1000 MAIN ST
CABOOL MO
65689-9125
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 Code314000000X
TaxonomySkilled Nursing Facility
License Number030908
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier26-5055
Identifier TypeOTHER
Identifier StateMO
Identifier IssuerOSCAR
# 2
Identifier101488500
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer

VIII. Authorized Official

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