Healthcare Provider Details

I. General information

NPI: 1467408716
Provider Name (Legal Business Name): FULTON RESIDENTIAL, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 11/10/2025
Certification Date: 11/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 N HOSPITAL DR
FULTON MO
65251-2511
US

IV. Provider business mailing address

120 N HOSPITAL DR
FULTON MO
65251-2511
US

V. Phone/Fax

Practice location:
  • Phone: 573-642-5222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: KYLE TIMOTHY SCHADE
Title or Position: MANAGER
Credential:
Phone: 573-471-1113