Healthcare Provider Details

I. General information

NPI: 1992873889
Provider Name (Legal Business Name): GOLDEN VALLEY MEMORIAL HOSPITAL HOME SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 02/23/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1703 N 2ND ST.
CLINTON MO
64735
US

IV. Provider business mailing address

1600 NORTH SECOND STREET
CLINTON MO
64735
US

V. Phone/Fax

Practice location:
  • Phone: 660-885-5088
  • Fax: 660-885-7756
Mailing address:
  • Phone: 660-885-5088
  • Fax: 660-885-7756

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MEREDITH COOPER
Title or Position: CLINIC ADMINISTRATOR
Credential:
Phone: 660-885-8171