Healthcare Provider Details

I. General information

NPI: 1427185206
Provider Name (Legal Business Name): PCRMC-HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 09/22/2022
Certification Date: 09/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E STATE HWY 72
ROLLA MO
65401-3926
US

IV. Provider business mailing address

1500 E STATE HWY 72
ROLLA MO
65401-3926
US

V. Phone/Fax

Practice location:
  • Phone: 573-364-2425
  • Fax: 573-364-3993
Mailing address:
  • Phone: 573-364-2425
  • Fax: 573-364-3993

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number0004588
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number0004588
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number0004588
License Number StateMO

VIII. Authorized Official

Name: JANA COOK
Title or Position: VP, CHIEF FINANCIAL OFFICER
Credential:
Phone: 573-458-7916