Healthcare Provider Details

I. General information

NPI: 1881730836
Provider Name (Legal Business Name): SHELBY COUNTY SENIOR CITIZENS ASSOCATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

112 E CHESTNUT ST
SHELBINA MO
63468-1339
US

IV. Provider business mailing address

112 E CHESTNUT ST
SHELBINA MO
63468-1339
US

V. Phone/Fax

Practice location:
  • Phone: 573-588-4403
  • Fax: 573-588-1406
Mailing address:
  • Phone: 573-588-4403
  • Fax: 573-588-1406

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MRS. DEBRA L SPARKS
Title or Position: MANAGER ADMINISTRATOR
Credential:
Phone: 573-588-4403