Healthcare Provider Details

I. General information

NPI: 1083081525
Provider Name (Legal Business Name): UNIVEST, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2015
Last Update Date: 12/09/2020
Certification Date: 12/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 E 24TH ST
SEDALIA MO
65301-8233
US

IV. Provider business mailing address

23200 CRAFTSMAN DR
SEDALIA MO
65301-4811
US

V. Phone/Fax

Practice location:
  • Phone: 660-827-3313
  • Fax:
Mailing address:
  • Phone: 785-217-5999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number043278
License Number StateMO

VIII. Authorized Official

Name: MS. SHAWN WOOLERY
Title or Position: MEMBER
Credential: RN
Phone: 785-217-5999