Healthcare Provider Details

I. General information

NPI: 1528283892
Provider Name (Legal Business Name): LOCH HAVEN APARTMENTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SUNSET HILLS DR
MACON MO
63552-2134
US

IV. Provider business mailing address

701 SUNSET HILLS DR PO BOX 187
MACON MO
63552-2134
US

V. Phone/Fax

Practice location:
  • Phone: 660-385-3113
  • Fax:
Mailing address:
  • Phone: 660-385-3113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number032683
License Number StateMO

VIII. Authorized Official

Name: MRS. BARBARA ANN PRIMM
Title or Position: ASSISTANT ADMINISTRATOR
Credential: BSN,RN,C
Phone: 660-385-3113