Healthcare Provider Details

I. General information

NPI: 1992004386
Provider Name (Legal Business Name): A TO Z WELLNESS AND REHAB SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 VINE ST
POPLAR BLUFF MO
63901-5039
US

IV. Provider business mailing address

600 VINE ST
POPLAR BLUFF MO
63901-5039
US

V. Phone/Fax

Practice location:
  • Phone: 573-776-6100
  • Fax: 573-776-6123
Mailing address:
  • Phone: 573-776-6100
  • Fax: 573-776-6123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: AMY MANCHESTER
Title or Position: CEO
Credential:
Phone: 573-776-6100