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General NPI Number Information
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NPI Number | 1316488075
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Entity Type | Organization
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Legal Business Name | SPIRIT 522 INC
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Dates
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Enumeration Date | 03/14/2017
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Last Update Date | 08/25/2022
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Provider Practice Location Address
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Address Line | 25466 HIGHWAY 5
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City | LEBANON
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State | MO
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Zip | 65536
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Country | US
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Telephone | 417-839-7637
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Fax | 417-473-6000
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Provider Business Mailing Address
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Address Line | PO BOX 389
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City | LEBANON
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State | MO
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Zip | 65536-0389
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Country | US
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Telephone | 417-839-7637
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Fax | 417-473-6000
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Authorized Official
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Title or Position | PRESIDENT
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Name | GAIL BROWN
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Credential |
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Telephone | 417-839-7637
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 313M00000X
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Taxonomy Name | Nursing Facility/Intermediate Care Facility
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License Number | LC001439602
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License Number State | MO
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