Healthcare Provider Details

I. General information

NPI: 1710289012
Provider Name (Legal Business Name): PHBC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2010
Last Update Date: 03/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 COUNTY FARM RD
CASSVILLE MO
65625-1726
US

IV. Provider business mailing address

7444 LONG AVE
SKOKIE IL
60077-3214
US

V. Phone/Fax

Practice location:
  • Phone: 417-847-3386
  • Fax:
Mailing address:
  • Phone: 847-329-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: BENJAMIN KLEIN
Title or Position: MANAGER
Credential:
Phone: 847-329-4100