Healthcare Provider Details

I. General information

NPI: 1922080886
Provider Name (Legal Business Name): CLOSE TO HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

609 S RAILROAD
MATTHEWS MO
63867-9751
US

IV. Provider business mailing address

258 N KINGSHIGHWAY ST
SIKESTON MO
63801-4102
US

V. Phone/Fax

Practice location:
  • Phone: 573-471-7861
  • Fax: 573-471-9527
Mailing address:
  • Phone: 573-471-5800
  • Fax: 573-471-6649

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number031384
License Number StateMO

VII. Legacy identifiers

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

VIII. Authorized Official

Name: MR. JOHN M. SELLS
Title or Position: PRESIDENT, CEO
Credential:
Phone: 573-471-5800