Healthcare Provider Details

I. General information

NPI: 1639372139
Provider Name (Legal Business Name): VELMA DOWDY RCF II
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HWY 60 EAST
FREMONT MO
63941-0278
US

IV. Provider business mailing address

PO BOX 278
FREMONT MO
63941-0278
US

V. Phone/Fax

Practice location:
  • Phone: 573-251-3555
  • Fax: 573-251-2589
Mailing address:
  • Phone: 573-251-3555
  • Fax: 573-251-2589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number032109
License Number StateMO

VIII. Authorized Official

Name: TONYA DEANN SHARP
Title or Position: OFFICE MANAGER BILLING
Credential:
Phone: 573-251-3555