Healthcare Provider Details

I. General information

NPI: 1578255337
Provider Name (Legal Business Name): HOME HEALTH OF THE OZARKS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2023
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1911 S NATIONAL AVE STE 105
SPRINGFIELD MO
65804-2213
US

IV. Provider business mailing address

1911 S NATIONAL AVE STE 105
SPRINGFIELD MO
65804-2213
US

V. Phone/Fax

Practice location:
  • Phone: 417-496-9143
  • Fax:
Mailing address:
  • Phone: 417-496-9143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: AMBER FANNIN
Title or Position: MANAGING MEMBER
Credential:
Phone: 417-496-9143