Healthcare Provider Details

I. General information

NPI: 1750379095
Provider Name (Legal Business Name): DADE COUNTY NURSING HOME DISTRICT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2005
Last Update Date: 02/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 BROAD ST
GREENFIELD MO
65661-1405
US

IV. Provider business mailing address

400 BROAD ST
GREENFIELD MO
65661-1405
US

V. Phone/Fax

Practice location:
  • Phone: 417-637-5315
  • Fax: 417-637-5281
Mailing address:
  • Phone: 417-637-5315
  • Fax: 417-637-5281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number031395
License Number StateMO

VIII. Authorized Official

Name: MRS. TERRIESHA ANN HUDDLESTON
Title or Position: ADMINISTRATOR
Credential:
Phone: 417-637-5315