Healthcare Provider Details

I. General information

NPI: 1033116819
Provider Name (Legal Business Name): HEALTH SERVICES OF DEXTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 BAILIFF DR
DEXTER MO
63841-9500
US

IV. Provider business mailing address

801 BAILIFF DR
DEXTER MO
63841-9500
US

V. Phone/Fax

Practice location:
  • Phone: 573-624-8908
  • Fax: 573-624-5193
Mailing address:
  • Phone: 573-624-8908
  • Fax: 573-624-5193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number029587
License Number StateMO

VIII. Authorized Official

Name: MR. JAMES REIKER
Title or Position: VICE PRESIDENT - FINANCE
Credential:
Phone: 573-471-1113