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General NPI Number Information
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NPI Number | 1275537714
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Entity Type | Organization
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Legal Business Name | SAC OSAGE HOME HEALTH CARE INC
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Dates
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Enumeration Date | 06/13/2005
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Last Update Date | 12/30/2011
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Provider Practice Location Address
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Address Line | 1780 E HIGHWAY 54
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City | EL DORADO SPRINGS
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State | MO
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Zip | 64744-8169
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Country | US
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Telephone | 417-876-5225
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Fax | 417-876-2058
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Provider Business Mailing Address
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Address Line | 1780 E HIGHWAY 54
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City | EL DORADO SPRINGS
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State | MO
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Zip | 64744-8169
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Country | US
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Telephone | 417-876-5225
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Fax | 417-876-2058
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | ROSE MOTT
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Credential |
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Telephone | 417-876-5225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | 743-2
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License Number State | MO
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