Healthcare Provider Details

I. General information

NPI: 1396153672
Provider Name (Legal Business Name): MERIDIAN HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2014
Last Update Date: 09/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 OLD EXETER RD
CASSVILLE MO
65625-1704
US

IV. Provider business mailing address

PO BOX 3068
FORT SMITH AR
72913-3068
US

V. Phone/Fax

Practice location:
  • Phone: 417-847-2184
  • Fax:
Mailing address:
  • Phone: 417-847-2184
  • Fax: 417-847-1069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number042508
License Number StateMO

VIII. Authorized Official

Name: MR. TODD PARKER HIGHTOWER
Title or Position: MANAGER
Credential:
Phone: 479-471-9797