Healthcare Provider Details

I. General information

NPI: 1902838980
Provider Name (Legal Business Name): WARRENSBURG 1 INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 S MITCHELL ST
WARRENSBURG MO
64093
US

IV. Provider business mailing address

PO BOX 1210
SIKESTON MO
63801-1210
US

V. Phone/Fax

Practice location:
  • Phone: 660-429-2177
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number046541
License Number StateMO

VIII. Authorized Official

Name: CLIFF SHIRRELL
Title or Position: VICE PRESIDENT
Credential:
Phone: 573-471-1276