Healthcare Provider Details

I. General information

NPI: 1750593554
Provider Name (Legal Business Name): MISSOURI VETERANS' COMMISSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR
MEXICO MO
65265
US

IV. Provider business mailing address

1 VETERANS DR
MEXICO MO
65265
US

V. Phone/Fax

Practice location:
  • Phone: 573-581-1088
  • Fax: 573-581-5356
Mailing address:
  • Phone: 573-581-1088
  • Fax: 573-581-5356

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CHERYL TOLBERT
Title or Position: ADMINISTRATOR
Credential:
Phone: 573-581-1088