Healthcare Provider Details

I. General information

NPI: 1447341763
Provider Name (Legal Business Name): SERVCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 10/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W HALL ST
OZARK MO
65721-9103
US

IV. Provider business mailing address

PO BOX 157
OZARK MO
65721-0157
US

V. Phone/Fax

Practice location:
  • Phone: 417-581-6025
  • Fax: 417-581-4652
Mailing address:
  • Phone: 417-581-6025
  • Fax: 417-581-4652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number032812
License Number StateMO

VII. Legacy identifiers

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

# 1
Identifier103060505
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer

VIII. Authorized Official

Name: DEAN T TLUSTOS
Title or Position: PRESIDENT/ADMINISTRATOR
Credential:
Phone: 417-581-6025