Healthcare Provider Details

I. General information

NPI: 1063010890
Provider Name (Legal Business Name): MITCHELL'S CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2020
Last Update Date: 10/14/2020
Certification Date: 10/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1134 W NORTON RD
SPRINGFIELD MO
65803-1070
US

IV. Provider business mailing address

1134 W NORTON RD
SPRINGFIELD MO
65803-1070
US

V. Phone/Fax

Practice location:
  • Phone: 417-766-9674
  • Fax:
Mailing address:
  • Phone: 417-766-9674
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MRS. MARTHA JO MITCHELL
Title or Position: ADMINISTRATOR
Credential:
Phone: 417-766-9674