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General NPI Number Information
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NPI Number | 1093020380
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Entity Type | Organization
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Legal Business Name | FOUR OAKS INC
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Dates
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Enumeration Date | 08/11/2010
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Last Update Date | 09/23/2014
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Provider Practice Location Address
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Address Line | 1615 W BUSINESS US HIGHWAY 60 SUITE A & B
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City | DEXTER
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State | MO
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Zip | 63841-2838
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Country | US
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Telephone | 573-624-3655
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Fax | 573-624-4323
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Provider Business Mailing Address
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Address Line | 731 N MAIN ST P.O. BOX 1210
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City | SIKESTON
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State | MO
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Zip | 63801-2151
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Country | US
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Telephone | 573-471-1276
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Fax | 573-472-8504
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. DONALD B BEDELL
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Credential |
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Telephone | 573-471-1276
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251G00000X
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Taxonomy Name | Community Based Hospice Care Agency
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License Number | 192-4HO
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License Number State | MO
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