Healthcare Provider Details

I. General information

NPI: 1013081017
Provider Name (Legal Business Name): TNMO HEALTHCARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1540 BRIDGESCHOOL RD
ROLLA MO
65401-8115
US

IV. Provider business mailing address

PO BOX 4060
MOORESVILLE NC
28117-4060
US

V. Phone/Fax

Practice location:
  • Phone: 573-364-3610
  • Fax: 573-641-9018
Mailing address:
  • Phone: 704-662-0416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number113306095
License Number StateMO

VII. Legacy identifiers

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

# 1
Identifier263446106
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer
# 2
Identifier853446102
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer
# 3
Identifier283446102
Identifier TypeMEDICAID
Identifier StateMO
Identifier Issuer

VIII. Authorized Official

Name: JANET COMBS
Title or Position: VP OF LICENSURE
Credential:
Phone: 704-664-2876