Healthcare Provider Details

I. General information

NPI: 1871630590
Provider Name (Legal Business Name): KNIGHTS OF COLUMBUS 3151 ST. FRANCIS XAVIER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 06/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

829 TANNER ST
SIKESTON MO
63801-2261
US

IV. Provider business mailing address

829 TANNER ST
SIKESTON MO
63801-2261
US

V. Phone/Fax

Practice location:
  • Phone: 573-471-1902
  • Fax: 573-471-3494
Mailing address:
  • Phone: 573-471-1902
  • Fax: 573-471-3494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number601
License Number StateMO

VIII. Authorized Official

Name: MRS. MARY E PEARSON
Title or Position: DIRECTOR
Credential:
Phone: 573-471-1902