Healthcare Provider Details

I. General information

NPI: 1700913589
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: 04/18/2023
Certification Date: 04/18/2023
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 TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number099-7HO
License Number StateMO

VIII. Authorized Official

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