=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053799338
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KEEPING GOOD COMPANY SENIOR CARE AT HOME, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/07/2015
-----------------------------------------------------
Last Update Date | 05/07/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7000 S SABINE DR
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65203-9347
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-445-0532
-----------------------------------------------------
Fax | 573-445-0532
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 7771
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65205-7771
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 573-445-0532
-----------------------------------------------------
Fax | 573-445-0532
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER, MANAGER
-----------------------------------------------------
Name | MRS. LORRAINE MARIE SCHILKE
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 573-864-6490
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | LC1337284
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------