Healthcare Provider Details

I. General information

NPI: 1801036967
Provider Name (Legal Business Name): ELECT INDEPENDENCE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2009
Last Update Date: 03/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

319 S MAIN ST SUITE F
ROGERSVILLE MO
65742-9361
US

IV. Provider business mailing address

319 S MAIN ST STE F PO BOX 204
ROGERSVILLE MO
65742-9424
US

V. Phone/Fax

Practice location:
  • Phone: 417-753-3700
  • Fax: 417-753-3706
Mailing address:
  • Phone: 417-753-3700
  • Fax: 417-753-3706

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberLC0864283
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: ALICIA ANN HAGEN
Title or Position: DIRECTOR
Credential:
Phone: 417-753-3700