=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497930549
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOUTHWEST MISSOURI HOMECARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/08/2008
-----------------------------------------------------
Last Update Date | 09/13/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1910 E BATTLEFIELD ST STE C
-----------------------------------------------------
City | SPRINGFIELD
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 65804-3878
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 417-882-7704
-----------------------------------------------------
Fax | 417-864-5930
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 51266
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70505-1266
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-233-1307
-----------------------------------------------------
Fax | 337-233-5764
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | JOSHUA L. PROFFITT
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 337-233-1307
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251J00000X
-----------------------------------------------------
Taxonomy Name | Nursing Care Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------