Healthcare Provider Details

I. General information

NPI: 1588737555
Provider Name (Legal Business Name): PEARLS RESIDENTIAL CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 S BROADWAY ST
PRINCETON MO
64673-1111
US

IV. Provider business mailing address

308 S BROADWAY ST
PRINCETON MO
64673-1111
US

V. Phone/Fax

Practice location:
  • Phone: 660-748-3307
  • Fax: 660-748-3307
Mailing address:
  • Phone: 660-748-3307
  • Fax: 660-748-3307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number043058
License Number StateMO

VIII. Authorized Official

Name: MRS. JUDY C BAGLEY
Title or Position: ADMINISTRATOR
Credential:
Phone: 660-748-4407