Healthcare Provider Details

I. General information

NPI: 1861931453
Provider Name (Legal Business Name): CASSVILLE OPERATIONS MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2017
Last Update Date: 02/16/2017
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

33 WEDGEWOOD LN
LAWRENCE NY
11559-1451
US

V. Phone/Fax

Practice location:
  • Phone: 417-847-3386
  • Fax:
Mailing address:
  • Phone: 917-836-0436
  • 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: GERALD STOLL
Title or Position: MANAGING MEMBER
Credential:
Phone: 917-836-0436