Healthcare Provider Details

I. General information

NPI: 1851844393
Provider Name (Legal Business Name): DESOTO INVESTMENT GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2016
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3260 BAISCH DR
DE SOTO MO
63020-5046
US

IV. Provider business mailing address

PO BOX 134
MOUNTAIN GROVE MO
65711-0134
US

V. Phone/Fax

Practice location:
  • Phone: 417-425-3062
  • Fax:
Mailing address:
  • Phone: 417-425-3062
  • 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: MRS. BROOKE MICHELLE BIGHAM
Title or Position: PRESIDENT
Credential:
Phone: 417-425-3062