Healthcare Provider Details

I. General information

NPI: 1689880239
Provider Name (Legal Business Name): BRISTOL CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/14/2007
Last Update Date: 10/02/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 N JEFFERSON ST
CENTRALIA MO
65240-1178
US

IV. Provider business mailing address

201 W 3RD ST
SEDALIA MO
65301-4352
US

V. Phone/Fax

Practice location:
  • Phone: 573-682-5913
  • Fax: 573-682-5913
Mailing address:
  • Phone: 660-826-0200
  • Fax: 660-827-2027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: SHELLEY DEANNE EBELING
Title or Position: MEDICAID BILLING DEPARTMENT
Credential:
Phone: 660-826-0200