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General NPI Number Information
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NPI Number | 1598371593
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Entity Type | Organization
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Legal Business Name | SCOTT CITY SUNSHINE LLC
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Dates
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Enumeration Date | 09/16/2020
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Last Update Date | 09/16/2020
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Provider Practice Location Address
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Address Line | 2520 JAMES ST
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City | SCOTT CITY
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State | MO
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Zip | 63780-1219
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Country | US
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Telephone | 573-264-2424
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Fax |
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Provider Business Mailing Address
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Address Line | 37 DOCTORS PARK STE 3
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City | CAPE GIRARDEAU
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State | MO
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Zip | 63703-4903
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KEVIN WOOD
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Credential |
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Telephone | 573-335-8207
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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 |
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License Number State |
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