Healthcare Provider Details

I. General information

NPI: 1023211091
Provider Name (Legal Business Name): EAST NEWTON CO R-VI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22808 E HIGHWAY 86
GRANBY MO
64844-7416
US

IV. Provider business mailing address

22808 E HIGHWAY 86
GRANBY MO
64844-7416
US

V. Phone/Fax

Practice location:
  • Phone: 417-472-6231
  • Fax: 417-472-3500
Mailing address:
  • Phone: 417-472-6231
  • Fax: 417-472-3500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: MRS. TANYA VEST
Title or Position: SUPERINTENDENT
Credential:
Phone: 417-472-6231