Healthcare Provider Details

I. General information

NPI: 1699559138
Provider Name (Legal Business Name): MASTER'S RANCH CHRISTIAN ACADEMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2023
Last Update Date: 08/24/2023
Certification Date: 08/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

287 COUNTY ROAD 275
MYRTLE MO
65778-8341
US

IV. Provider business mailing address

PO BOX 709
MYRTLE MO
65778-0709
US

V. Phone/Fax

Practice location:
  • Phone: 417-264-6040
  • Fax:
Mailing address:
  • Phone: 417-264-6040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code322D00000X
TaxonomyEmotionally Disturbed Childrens' Residential Treatment 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: DR. KENNETH TOMBLEY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: LPC
Phone: 417-274-0469