Healthcare Provider Details

I. General information

NPI: 1265684922
Provider Name (Legal Business Name): BENCHMARK HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2008
Last Update Date: 10/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28601 US HIGHWAY 61
SCOTT CITY MO
63780-9143
US

IV. Provider business mailing address

28601 US HIGHWAY 61
SCOTT CITY MO
63780-9143
US

V. Phone/Fax

Practice location:
  • Phone: 573-264-1555
  • Fax: 573-264-1556
Mailing address:
  • Phone: 573-264-1555
  • Fax: 573-264-1556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number029719
License Number StateMO

VIII. Authorized Official

Name: MRS. DERENDA DIANE TIPPY
Title or Position: EXECUTIVE DIRECTOR
Credential: LPN/ADM
Phone: 573-264-1555