Healthcare Provider Details

I. General information

NPI: 1205865953
Provider Name (Legal Business Name): BOONE COUNTY SENIOR CITIZEN SERVICE CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2006
Last Update Date: 07/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3105 BLUFF CREEK DRIVE
COLUMBIA MO
65201-3529
US

IV. Provider business mailing address

3105 BLUFF CREEK DR
COLUMBIA MO
65201-3529
US

V. Phone/Fax

Practice location:
  • Phone: 573-442-6060
  • Fax: 573-875-8060
Mailing address:
  • Phone: 573-442-6060
  • Fax: 573-874-8060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number032158
License Number StateMO

VIII. Authorized Official

Name: MRS. ASHA SHAON
Title or Position: DIRECTOR OF FINANCE
Credential:
Phone: 573-442-6060