Healthcare Provider Details

I. General information

NPI: 1023158532
Provider Name (Legal Business Name): ARROWHEAD ADULT DAYCARE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2163 HIGHWAY 32
HALF WAY MO
65663
US

IV. Provider business mailing address

2163 HIGHWAY 32
HALFWAY MO
65663
US

V. Phone/Fax

Practice location:
  • Phone: 417-445-5412
  • Fax: 417-445-5412
Mailing address:
  • Phone: 417-445-5412
  • Fax: 417-445-5412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number669
License Number StateMO

VIII. Authorized Official

Name: MRS. SHANNON PAYNE
Title or Position: OWNER
Credential:
Phone: 417-445-5412