Healthcare Provider Details

I. General information

NPI: 1558283234
Provider Name (Legal Business Name): NEVADA EXTENDED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2026
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 E ASHLAND ST
NEVADA MO
64772-4025
US

IV. Provider business mailing address

1505 E ASHLAND ST
NEVADA MO
64772-4025
US

V. Phone/Fax

Practice location:
  • Phone: 417-599-9962
  • Fax:
Mailing address:
  • Phone: 417-599-9962
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: MARTIN TYLER
Title or Position: OPERATIONS MANAGER
Credential:
Phone: 417-667-3700