Healthcare Provider Details

I. General information

NPI: 1548265176
Provider Name (Legal Business Name): JOHNSON COUNTY COMMUNITY HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 12/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

723 PCA RD
WARRENSBURG MO
64093-7913
US

IV. Provider business mailing address

723 PCA RD
WARRENSBURG MO
64093-7913
US

V. Phone/Fax

Practice location:
  • Phone: 660-747-6121
  • Fax: 660-747-6087
Mailing address:
  • Phone: 660-747-6121
  • Fax: 660-747-6087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DEBORAH K HALLER
Title or Position: ADMINISTRATOR
Credential: RN, BSN
Phone: 660-747-6121