Healthcare Provider Details

I. General information

NPI: 1619151453
Provider Name (Legal Business Name): GREATER HEIGHTS ADHC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 01/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

719 MAPLE ST
FARMINGTON MO
63640-1925
US

IV. Provider business mailing address

719 MAPLE ST
FARMINGTON MO
63640-1925
US

V. Phone/Fax

Practice location:
  • Phone: 573-756-7554
  • Fax: 573-756-0227
Mailing address:
  • Phone: 573-756-7554
  • Fax: 573-756-0227

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number724
License Number StateMO

VIII. Authorized Official

Name: RODNEY GREENWALT
Title or Position: OWNER
Credential:
Phone: 573-756-7554