Healthcare Provider Details

I. General information

NPI: 1447236575
Provider Name (Legal Business Name): SOUTHEAST HEALTH CENTER OF RIPLEY COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 03/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 N GRAND AVE
DONIPHAN MO
63935-1768
US

IV. Provider business mailing address

208 N GRAND AVE
DONIPHAN MO
63935-1768
US

V. Phone/Fax

Practice location:
  • Phone: 573-996-2141
  • Fax: 573-996-4151
Mailing address:
  • Phone: 573-996-2141
  • Fax: 573-996-4151

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number851-HH
License Number StateMO

VIII. Authorized Official

Name: MRS. PAULA E HARRIS
Title or Position: VP REGIONAL OPERATIONS
Credential:
Phone: 573-778-0020