Healthcare Provider Details

I. General information

NPI: 1790879500
Provider Name (Legal Business Name): CHRISTIAN HEALTH CARE OF SPRINGFIELD WEST PARK
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3405 W MOUNT VERNON ST
SPRINGFIELD MO
65802-5241
US

IV. Provider business mailing address

5302 VILLAGE PKWY SUITE 1
ROGERS AR
72758-8102
US

V. Phone/Fax

Practice location:
  • Phone: 417-891-9939
  • Fax: 417-891-9928
Mailing address:
  • Phone: 479-464-0200
  • Fax: 479-464-8098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number027442
License Number StateMO

VII. Legacy identifiers

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

VIII. Authorized Official

Name: THOMAS STAYTON
Title or Position: PRESIDENT
Credential:
Phone: 417-891-9939