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General NPI Number Information
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NPI Number | 1467449413
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Entity Type | Organization
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Legal Business Name | VILLAGE CARE CENTER, INC
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Dates
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Enumeration Date | 10/04/2005
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Last Update Date | 03/28/2012
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Provider Practice Location Address
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Address Line | 810 E EDWARDS ST
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City | MARYVILLE
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State | MO
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Zip | 64468-2917
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Country | US
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Telephone | 660-562-3515
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Fax | 660-562-3658
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Provider Business Mailing Address
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Address Line | 810 E EDWARDS ST
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City | MARYVILLE
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State | MO
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Zip | 64468-2917
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Country | US
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Telephone | 660-562-3515
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Fax | 660-562-3658
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | KELLY SUMMA
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Credential |
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Telephone | 660-562-3515
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 031589
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License Number State | MO
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