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General NPI Number Information
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NPI Number | 1477975183
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Entity Type | Organization
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Legal Business Name | KRC 1505 HEALTH CARE SERVICES LLC
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Dates
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Enumeration Date | 01/15/2014
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Last Update Date | 01/15/2014
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Provider Practice Location Address
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Address Line | 1505 EAST ASHLAND STREET
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City | NEVADA
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State | MO
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Zip | 64772
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Country | US
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Telephone | 417-667-3900
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Fax | 417-667-3923
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Provider Business Mailing Address
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Address Line | 1505 E ASHLAND ST
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City | NEVADA
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State | MO
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Zip | 64772-4025
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Country | US
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Telephone | 417-667-3900
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Fax | 417-667-3923
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | KAREN CLARK
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Credential |
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Telephone | 417-667-3900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 041595
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License Number State | MO
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