Healthcare Provider Details

I. General information

NPI: 1134753593
Provider Name (Legal Business Name): FRIENDS OF ST. CLAIR COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2020
Last Update Date: 08/02/2021
Certification Date: 08/02/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5345 BUS HWY 13 NE
OSCEOLA MO
64776
US

IV. Provider business mailing address

PO BOX 502
OSCEOLA MO
64776-0502
US

V. Phone/Fax

Practice location:
  • Phone: 417-646-2024
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. STANLEY HAYES JR.
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 660-351-3550