Healthcare Provider Details

I. General information

NPI: 1023942224
Provider Name (Legal Business Name): MIDWEST DIVISION - LRHC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2026
Last Update Date: 06/11/2026
Certification Date: 06/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 MAIN ST
LEXINGTON MO
64067-1822
US

IV. Provider business mailing address

2108 MAIN ST
LEXINGTON MO
64067-1822
US

V. Phone/Fax

Practice location:
  • Phone: 660-259-4448
  • Fax:
Mailing address:
  • Phone: 660-259-4448
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number State

VIII. Authorized Official

Name: DARREL WILLIAM BOX
Title or Position: CEO
Credential:
Phone: 660-259-6852