Healthcare Provider Details

I. General information

NPI: 1356561328
Provider Name (Legal Business Name): MISSOURI VETERANS COMMISSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N JEFFERSON ST
SAINT JAMES MO
65559-1926
US

IV. Provider business mailing address

620 N JEFFERSON ST
SAINT JAMES MO
65559-1926
US

V. Phone/Fax

Practice location:
  • Phone: 573-265-3271
  • Fax: 573-265-5771
Mailing address:
  • Phone: 573-265-3271
  • Fax: 573-265-5771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateMO

VIII. Authorized Official

Name: PATTY FAENGER
Title or Position: ADMINISTRATOR
Credential:
Phone: 573-265-3271