Healthcare Provider Details

I. General information

NPI: 1336118397
Provider Name (Legal Business Name): COMMUNITY HOSPITAL ASSOCIATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 03/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26136 US HIGHWAY 59
FAIRFAX MO
64446-8155
US

IV. Provider business mailing address

26136 US HIGHWAY 59 P.O. BOX 107
FAIRFAX MO
64446-9105
US

V. Phone/Fax

Practice location:
  • Phone: 660-686-2211
  • Fax: 660-686-2618
Mailing address:
  • Phone: 660-686-2211
  • Fax: 660-686-2799

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number345-13
License Number StateMO

VIII. Authorized Official

Name: MRS. MYRA EVANS
Title or Position: ADMINISTRATOR
Credential:
Phone: 660-686-2211