Healthcare Provider Details

I. General information

NPI: 1942521984
Provider Name (Legal Business Name): HARRISONVILLE HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2010
Last Update Date: 11/08/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

307 E SOUTH ST
HARRISONVILLE MO
64701-3241
US

IV. Provider business mailing address

17826 EDISON AVE
CHESTERFIELD MO
63005-1262
US

V. Phone/Fax

Practice location:
  • Phone: 816-380-7399
  • Fax: 816-380-6352
Mailing address:
  • Phone: 636-536-5365
  • Fax: 636-536-4533

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. JOHN M. SELLS
Title or Position: PRESIDENT
Credential:
Phone: 636-536-5365