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General NPI Number Information
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NPI Number | 1386703452
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Entity Type | Organization
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Legal Business Name | CAPE HOME OXYGEN, LLC
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Dates
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Enumeration Date | 12/06/2006
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Last Update Date | 10/02/2012
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Provider Practice Location Address
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Address Line | 1009 HICKORY LOG DR
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City | DEXTER
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State | MO
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Zip | 63841-1664
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Country | US
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Telephone | 573-624-2300
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Fax | 573-624-3700
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Provider Business Mailing Address
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Address Line | 1009 HICKORY LOG DR
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City | DEXTER
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State | MO
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Zip | 63841-1664
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Country | US
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Telephone | 573-624-2300
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Fax | 573-624-3700
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Authorized Official
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Title or Position | OWNER
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Name | JEFFERY W BUSH
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Credential |
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Telephone | 573-624-2300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0000
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License Number State | MO
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