Healthcare Provider Details

I. General information

NPI: 1033100029
Provider Name (Legal Business Name): CARTER COUNTY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2005
Last Update Date: 08/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 HEALTH CENTER ROAD
VAN BUREN MO
63965-0070
US

IV. Provider business mailing address

1611 HEALTH CENTER ROAD
VAN BUREN MO
63965-0070
US

V. Phone/Fax

Practice location:
  • Phone: 573-323-4627
  • Fax: 573-323-8703
Mailing address:
  • Phone: 573-323-4627
  • Fax: 573-323-8703

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number32-31
License Number StateMO

VIII. Authorized Official

Name: DEBORAH SANDARCIERO
Title or Position: ADMINISTRATOR
Credential: R.N.
Phone: 573-323-4627