Healthcare Provider Details

I. General information

NPI: 1730841230
Provider Name (Legal Business Name): MARSHFIELD HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2021
Last Update Date: 10/12/2021
Certification Date: 09/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S WHITE OAK RD
MARSHFIELD MO
65706-2231
US

IV. Provider business mailing address

110 ROCKAWAY TPKE STE 6
LAWRENCE NY
11559-1626
US

V. Phone/Fax

Practice location:
  • Phone: 417-859-3701
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BERNARD DAVID PERLOW
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 443-928-3278