Healthcare Provider Details

I. General information

NPI: 1316129208
Provider Name (Legal Business Name): SOUTHWEST MISSOURI HOMECARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/03/2007
Last Update Date: 12/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 E INDEPENDENCE ST SUITE 100
SPRINGFIELD MO
65804-4386
US

IV. Provider business mailing address

PO BOX 51266
LAFAYETTE LA
70505-1266
US

V. Phone/Fax

Practice location:
  • Phone: 417-863-7100
  • Fax: 417-863-7204
Mailing address:
  • Phone: 337-233-1307
  • Fax: 337-233-5764

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number505
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. DONALD D. STELLY
Title or Position: PRESIDENT
Credential:
Phone: 337-233-1307