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General NPI Number Information
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NPI Number | 1487705067
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Entity Type | Organization
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Legal Business Name | TRI-COUNTY GROUP XV, INC.
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Dates
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Enumeration Date | 01/12/2007
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Last Update Date | 04/11/2025
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Provider Practice Location Address
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Address Line | 2016 N WESTWOOD BLVD STE 1
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-2810
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Country | US
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Telephone | 888-824-1505
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Fax | 573-776-6050
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Provider Business Mailing Address
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Address Line | 3010 LYNDON B JOHNSON FWY STE 1100
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City | DALLAS
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State | TX
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Zip | 75234-2712
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Country | US
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Telephone | 517-768-4373
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Fax | 903-537-8420
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Authorized Official
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Title or Position | COMPLIANCE PRIVACY & SAFETY OFFICER
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Name | KATIE LYNN MONASTIERE
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Credential |
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Telephone | 517-768-4373
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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 |
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License Number State | MO
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